title: Systemic therapy of metastatic breast cancer: the truth beyond the clinical trials.
abstract: OBJECTIVE
  To depict a clear and coherent picture of the overall course of palliative treatment in an unselected study cohort over the course of time.
  
  
  METHODS
  We compared therapy type and course of 242 women whose distant metastatic disease was diagnosed from 1990 to 2006 and who ultimately died of the disease. We divided the patients into two subgroups depending on the year of diagnosis of metastases (group A: 1998-2006 vs. group B: 1990-1997).
  
  
  RESULTS
  In both subgroups, there were no significant differences in the general type of treatment and the number of administered therapy lines (no systemic therapy: 12.9 vs.13.7%, p = 0.848; endocrine therapy only: 20.4 vs. 25.2%, p = 0.430; chemotherapy only: 18.4 vs.16.9%, p = 0.735; sequential combination regimen including endocrine therapy/chemotherapy/trastuzumab: 46.9 vs. 44.2%, p = 0.694; median: 2 lines). In the cases where chemotherapy was administered, there were no differences between the number of lines among older and younger patients (median: two lines; >or=70 years vs. <70 years: p = 0.269). The median metastatic disease-specific survival increased from 16 months in the period from 1990 to 1997, to 21 months in the period from 1998 to 2000 (p = 0.062).
  
  
  CONCLUSIONS
  The number of patients who died from metastatic breast cancer without receiving any antineoplastic therapy was surprisingly high. The use of newer agents and regimens in the treatment of metastatic breast cancer was associated with an improved survival over time. Chemotherapy is a feasible option also among older patients.
authors.affiliation: Department of Gynecology and Obstetrics, University Hospital Basel, Basel, Switzerland. ugueth@uhbs.ch
authors.forename: Uwe
authors.initials: U
authors.lastname: Gueth
authors.forename: Dorothy Jane
authors.initials: DJ
authors.lastname: Huang
authors.forename: Andreas
authors.initials: A
authors.lastname: Schoetzau
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Holzgreve
authors.forename: Edward
authors.initials: E
authors.lastname: Wight
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D002986:Clinical Trials as Topic; D005260:Female; D006801:Humans; D008875:Middle Aged; D009362:Neoplasm Metastasis; D010166:Palliative Care