Study summary · research use only
Breast cancer (metastatic)
Plain-language summary
Paraphrased from the published abstract below — not a verdict on whether anything works.
This systematic review of human clinical evidence on metastatic breast cancer states median survival without treatment is 12 months, though survival up to 20 years has been reported in younger patients. The review searched Medline, Embase, the Cochrane Library, and other databases through June 2009, identifying 77 systematic reviews, RCTs, or observational studies, graded using GRADE methodology, addressing first- and second-line hormonal treatment, first- and second-line chemotherapy, chemotherapy combined with a monoclonal antibody, and treatments for bone, spinal cord, cerebral, or choroidal metastases. It presents evidence on interventions including tamoxifen, ovarian ablation, progestins, aromatase inhibitors, gonadorelin analogues, taxane- and non-taxane-based chemotherapy, bevacizumab, trastuzumab, lapatinib, capecitabine, vinca alkaloids, bisphosphonates, intrathecal chemotherapy, radiotherapy, and surgical resection.
Abstract
Median survival from metastatic breast cancer is 12 months without treatment, but young people can survive up to 20 years with the disease, whereas in other metastatic cancers this would be considered unusual. We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of first-line hormonal treatment? What are the effects of second-line hormonal treatment in women who have not responded to tamoxifen? What are the effects of first-line chemotherapy? What are the effects of first-line chemotherapy in combination with a monoclonal antibody? What are the effects of second-line chemotherapy? What are the effects of treatments for bone metastases? What are the effects of treatments for spinal cord metastases? What are the effects of treatments for cerebral or choroidal metastases? We searched: Medline, Embase, The Cochrane Library, and other important databases up to June 2009 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). We found 77 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. In this systematic review we present information relating to the effectiveness and safety of the following interventions: first-line hormonal treatment using anti-oestrogens (tamoxifen), ovarian ablation, progestins, selective aromatase inhibitors, or combined gonadorelin analogues plus tamoxifen; second-line hormonal treatment using progestins or selective aromatase inhibitors; first-line non-taxane combination chemotherapy; first-line taxane-based combination chemotherapy; first-line high- versus low-dose standard chemotherapy; first-line chemotherapy plus monoclonal antibody (bevacizumab, trastuzumab); first-line chemotherapy plus tyrosine kinase inhibitor (lapatinib); second-line taxane-based combination chemotherapy; second-line capecitabine or semi-synthetic vinca alkaloids for anthracycline-resistant disease; second-line chemotherapy plus tyrosine kinase inhibitor (lapatinib); and treatment for bone, spinal, or choroidal metastases using bisphosphonates, intrathecal chemotherapy, radiotherapy (alone or plus corticosteroids) radiation sensitisers, or surgical resection.
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