Clinical considerations in the optimisation of gemcitabine plus taxane as first-line treatment for metastatic breast cancer

ABSTRACTCombining gemcitabine with a taxane has produced impressive results in metastatic breast cancer: gemcitabine plus paclitaxel has shown good efficacy with respect to response rates, time to disease progression and overall survival; gemcitabine plus docetaxel also offers an effective option. Both gemcitabine combinations are less toxic than capecitabine plus docetaxel, and efficacy is unlikely to be compromised by selecting one gemcitabine plus taxane combination over the other. In the majority of trials, taxane combinations have led to significantly better overall survival than taxane monotherapy. One option for optimising gemcitabine plus taxane combinations is to increase dose density: a dose-dense schedule can achieve a greater and often more rapid reduction in tumour burden, without the risk of regrowth. Trials are also under way to compare bi-weekly schedules with standard schedules. One further option is to combine gemcitabine plus taxane with molecular-targeting agents, which has shown promising preliminary data, and trial results are eagerly awaited.