Also, the categories do not indicate whether a particular treatment is generally appropriate or whether it is suitable for a particular individual. (BMJ 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). Results We found 63 systematic reviews, RCTs, or observational studies that met our inclusion criteria. Conclusions In this systematic review we present information relating to the effectiveness and safety of the following interventions: anthracycline-based non-taxane combination chemotherapy regimens; bisphosphonates; capecitabine or semisynthetic vinca alkaloids for anthracycline-resistant disease; chemotherapy plus monoclonal antibody (trastuzumab); classical non-taxane combination chemotherapy; combined gonadorelin analogues plus tamoxifen; hormonal treatment with antioestrogens (tamoxifen) or progestins; intrathecal chemotherapy; non-anthracycline-based regimens; non-taxane combination chemotherapy; ovarian ablation; radiation sensitisers; radiotherapy (alone, or plus appropriate analgesia, or plus high-dose corticosteroids); selective aromatase inhibitors; chemotherapy (standard, or high dose); surgical resection; tamoxifen; and taxane-based combination chemotherapy. Key Points 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 very unusual. Antioestrogens (tamoxifen) result in tumour responses in about a third of women with oestrogen receptor positive metastatic breast cancer when used as first line treatment, but most women eventually develop resistant disease. Progestins and ovarian ablation may be as effective as tamoxifen, while adding tamoxifen to gonadorelin analogues increases survival and response rates. Selective aromatase inhibitors may be as effective as tamoxifen, and more effective than progestins in delaying disease progression as first or second line treatment in postmenopausal women, with similar overall survival. The benefit may be best in oestrogen receptor positive women. Hormonal treatment using tamoxifen or progestins may be preferable to chemotherapy as first line treatment in women with oestrogen receptor positive disease. First line chemotherapy is usually associated with an objective tumour response in 40-60% of women, of median duration of 6-12 KX-01-191 months. Complete remission may occur in some women, whereas others show little or no response at all. Classical non-taxane combination chemotherapy, especially those containing anthracyclines, may be more effective than altered regimens and as effective as hormonal treatments in prolonging survival. The optimum duration of chemotherapy is usually unknown. Increasing the dose may increase serious adverse effects without prolonging survival. Taxane based chemotherapy may increase tumour response and survival compared with some non-taxane regimens as second line treatment. No clear benefit has been found in first line treatment. Adding trastuzumab to standard chemotherapy increases response rates and overall survival in women with overexpression, but risks of cardiac function are increased in women also receiving anthracyclines. Bisphosphonates reduce skeletal complications from bone metastases, while radiotherapy may reduce pain and complications from bone metastases, cranial nerve or spinal cord compression, and in brain or choroidal metastases. About this condition Definition Metastatic or advanced breast cancer is the presence of disease at distant sites such as the bone, liver, or lung. Symptoms may include pain from bone metastases, breathlessness from spread to the lungs, and nausea or abdominal discomfort from liver involvement. Incidence/ Prevalence Breast cancer is the second most frequent cancer in the world, and is by KX-01-191 far the most common malignant disease in women (22% of all new cancer cases). Worldwide, the ratio of mortality to incidence is about 36%. It ranks fifth as a cause of death from cancer overall (although it is the leading cause of cancer mortality in women??the 370?000 annual deaths represent 13.9% of cancer deaths in women). In the USA, metastatic breast cancer causes 46?000 deaths annually, and in the UK causes 15?000 deaths annually. It is the most prevalent cancer in the world today and there are an estimated 3.9 million women alive who have had breast cancer diagnosed in the past 5 years (compared, for example, with lung cancer, where there are 1.4 million alive). The true prevalence of metastatic disease is high because some women live with the disease for many years. Since 1990, there has been an overall increase in incidence rates of about 1.5% annually. Aetiology/ Risk factors The risk of metastatic disease relates to known adverse prognostic factors in the original primary tumour. These factors include oestrogen receptor negative disease, primary tumours 3?cm or more in diameter, and axillary node involvement??recurrence occurred within 10 years of adjuvant chemotherapy for early.Design criteria included: systematic reviews and RCTs in the English language. 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). Results We found 63 systematic reviews, RCTs, or observational studies that met our inclusion criteria. Conclusions In this systematic review we present information relating to the effectiveness and safety of the following interventions: anthracycline-based non-taxane combination chemotherapy regimens; bisphosphonates; capecitabine or semisynthetic vinca alkaloids for anthracycline-resistant disease; chemotherapy plus monoclonal antibody (trastuzumab); classical non-taxane combination chemotherapy; combined gonadorelin analogues plus tamoxifen; hormonal treatment with antioestrogens (tamoxifen) or progestins; intrathecal chemotherapy; non-anthracycline-based regimens; non-taxane combination chemotherapy; ovarian ablation; radiation sensitisers; radiotherapy (alone, or plus appropriate analgesia, or plus high-dose corticosteroids); selective aromatase inhibitors; chemotherapy (standard, or high dose); surgical resection; tamoxifen; and taxane-based combination chemotherapy. Key Points 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 very unusual. Antioestrogens (tamoxifen) result in tumour responses in about a third of women with oestrogen receptor positive metastatic breast cancer when used as first line treatment, but most women eventually develop resistant disease. Progestins and ovarian ablation may be as effective as tamoxifen, while adding tamoxifen to gonadorelin analogues increases survival and response rates. Selective aromatase inhibitors may be as effective as tamoxifen, and more effective than progestins in delaying disease progression as first or second line treatment in postmenopausal women, with similar overall survival. The benefit may be greatest in oestrogen receptor positive women. Hormonal treatment using tamoxifen or progestins may be preferable to chemotherapy as first line treatment in women with oestrogen receptor positive disease. First line chemotherapy is associated with an objective tumour response in 40-60% of women, of median duration of 6-12 months. Complete remission may occur in some women, whereas others show little or no response at all. Classical non-taxane combination chemotherapy, especially those containing anthracyclines, may be more effective than modified regimens and as effective as hormonal treatments in prolonging survival. The optimum duration of chemotherapy is unknown. Increasing the dose may increase serious adverse effects without prolonging survival. Taxane based chemotherapy may increase tumour response and survival compared with some non-taxane regimens as second line treatment. No clear benefit has been found in first line treatment. Adding trastuzumab to standard chemotherapy increases response rates and overall survival in women with overexpression, but risks of cardiac function are increased in women also receiving anthracyclines. Bisphosphonates reduce skeletal complications from bone metastases, while radiotherapy may reduce pain and complications from bone metastases, cranial nerve or spinal cord compression, and in brain or choroidal metastases. About this condition Definition Metastatic or advanced breast cancer is the presence of disease at distant sites such as the bone, liver, or lung. Symptoms may include pain from bone metastases, breathlessness from spread to the lungs, and nausea or abdominal distress from liver involvement. Incidence/ Prevalence Breast cancer is the second most frequent tumor in the world, and is by far the most common malignant disease in ladies (22% of all new cancer instances). Worldwide, the percentage of mortality to incidence is about 36%. It ranks fifth Sav1 like a cause of death from malignancy overall (although it is the leading cause of tumor mortality in ladies??the 370?000 annual deaths represent 13.9% of cancer deaths in women). In the USA, metastatic breast tumor causes 46?000 deaths annually, and in the UK causes 15?000 deaths annually. It is the most prevalent cancer in the world today and you will find an estimated 3.9 million women alive who have experienced breast cancer diagnosed in the past 5 years (compared, for example, with lung cancer, where there are 1.4 million alive). The true prevalence of metastatic disease is definitely high because some ladies live with the disease for many years. Since 1990, there has been an overall increase in incidence rates of about 1.5% annually. Aetiology/ Risk factors The risk of metastatic disease KX-01-191 relates to known adverse prognostic factors in the original main tumour. These factors include oestrogen.
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