Metastatic breast cancer: why are we here and where are we going?

The 1990s might be viewed as a golden age for the therapy of metastatic breast cancer with the introduction of new cytotoxic drugs and regimens to improve quality of life and prolong survival. The taxanes and anthracyclines have emerged as the most active agents, and investigation of these drug classes in combination has been eagerly pursued. Increased understanding of the biology of breast cancer is providing novel treatment approaches. Trastuzumab, a monoclonal antibody directed against the HER-2/neu protein, has become an important therapeutic option for patients with HER-2/neu-positive metastatic breast cancer. Other molecularly targeted therapeutic interventions are being introduced and are under current development. There are many reasons for optimism for the future regarding the treatment of metastatic breast cancer. This devastating disease poses a major challenge, but after decades of clinical trials and many attempts to refine the use of chemotherapy, we are now moving into a more informed era.