Going Beyond Anthracyclines and Taxanes in Breast Cancer - What's Next?

In recent years, a clear trend has been observed for taxanes to be used earlier in the course of breast cancer, with a large proportion of patients previously treated with anthracyclines and/or taxanes in the (neo)adjuvant setting. In addition, tolerability issues associated with taxane use in elderly patients and patients with substantial comorbidity, means that taxane use is frequently compromised in a substantial proportion of patients with metastatic breast cancer (MBC). Retreatment with taxanes yields variable results, and alternative cytotoxic agents with good activity in patients with anthracycline- and taxane-pretreated MBC are required. Large studies and meta-analyses have helped to establish the role of anthracycline- and taxane-based adjuvant therapy for early breast cancer (EBC). Addition of further cytotoxic agents has generally met with little success, thus the focus has moved towards optimization of adjuvant therapy through scheduling and patient selection. This review considers recent and ongoing developments in the chemotherapeutic management of EBC and MBC.