Review of gemcitabine plus taxane combination therapy in the first-line treatment of metastatic breast cancer

The development of new chemotherapeutic therapies has led to an increase in treatment options for metastatic breast cancer. Using different types of agents in combination has resulted in anti-tumour activity that is greater than can be achieved with single-agent therapy, and has contributed to an increase in survival rates in the last 20 years. Some drug combinations only display synergistic effects when they are used in a certain sequence, and this is particularly true of the combination of a taxane followed by gemcitabine. Gemcitabine plus paclitaxel was recently added to the preferred combinations of the National Comprehensive Cancer Network Practice Guidelines in Oncology, as it demonstrated an increased time to disease progression and overall survival when compared with paclitaxel alone. The combination of gemcitabine plus docetaxel demonstrated similar efficacy to capecitabine plus docetaxel, but was associated with fewer drug-related discontinuations. Bi-weekly dosing regimens may optimise synergistic mechanisms and should be tested further in randomised clinical trials.