title: Cytotoxic drugs for patients with breast cancer in the era of targeted treatment: back to the future?
abstract: BACKGROUND
  Despite current trend of targeted therapy development, cytotoxic agents are a mainstay of treatment of patients with breast cancer. We reviewed recent advances in cytotoxic therapy for patients with metastatic breast cancer (MBC).
  
  
  METHODS
  Medline searches were conducted for English language studies using the term 'MBC' and 'cytotoxic drugs'. The data search was restricted to the period 2000-2011.
  
  
  RESULTS
  Several novel cytotoxic compounds, all microtubule inhibitors, have been approved for clinical use in MBC: (i) nab-paclitaxel, reported to improve tumour response and decrease hypersensitivity reactions in comparison with other taxanes; (ii) ixabepilone, shown to have clinical benefit in taxane- and anthracycline-resistant disease and (iii) eribulin, shown to improve overall survival in heavily pre-treated patients, when compared with best available standard treatment. Agents, such as larotaxel, vinflunine, trabectidin and formulations, including cationic liposomal paclitaxel or paclitaxel poliglumex, are currently under evaluation in phase II/III trials.
  
  
  CONCLUSIONS
  Toxicity and chemotherapy resistance are still major limitations in the treatment of patients with MBC. Further research into new cytotoxic compounds is needed in order to maximise benefit, whilst minimising toxicity.
authors: Division of Medical Oncology, University of Lisboa Medical School, Centro Hospitalar Lisboa Norte, Lisboa, Portugal.
authors: J T
authors: JT
authors: Ribeiro
authors: Division of Medical Oncology, Hospital de Clinicas, State University Medical School of Campinas, Campinas, Brazil.
authors: L T
authors: LT
authors: Macedo
authors: Division of Medical Oncology, Department of Medicine, European Institute of Oncology, Milan, Italy. Electronic address: giuseppe.curigliano@ieo.it.
authors: G
authors: G
authors: Curigliano
authors: Division of Medical Oncology, Department of Medicine, European Institute of Oncology, Milan, Italy.
authors: L
authors: L
authors: Fumagalli
authors: Division of Medical Oncology, Department of Medicine, European Institute of Oncology, Milan, Italy.
authors: M
authors: M
authors: Locatelli
authors: Oxford University Medical School, Brasenose College, University of Oxford, Oxford, UK.
authors: M
authors: M
authors: Dalton
authors: Division of Medical Oncology, University of Lisboa Medical School, Centro Hospitalar Lisboa Norte, Lisboa, Portugal.
authors: A
authors: A
authors: Quintela
authors: Division of Medical Oncology, Hospital de Clinicas, State University Medical School of Campinas, Campinas, Brazil.
authors: J B C
authors: JBC
authors: Carvalheira
authors: Sassari University Medical School, Ospedale S. Campus, Sassari, Italy.
authors: S
authors: S
authors: Manunta
authors: Division of Medical Oncology, Department of Medicine, European Institute of Oncology, Milan, Italy.
authors: L
authors: L
authors: Mazzarella
authors: Division of Medical Oncology, Department of Medicine, European Institute of Oncology, Milan, Italy.
authors: J
authors: J
authors: Brollo
authors: Division of Medical Oncology, Department of Medicine, European Institute of Oncology, Milan, Italy.
authors: A
authors: A
authors: Goldhirsch
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy*; D002986:Clinical Trials as Topic; D003603:Cytotoxins / Q000627:therapeutic use*; D005260:Female; D006801:Humans
chemical_list: D000970:Antineoplastic Agents; D003603:Cytotoxins