Time for more optimism in metastatic breast cancer?

Treatment of metastatic breast cancer has substantially changed in the last decades. Availability of new cytotoxics and targeted therapies as well as changes in treatment philosophy and strategy have all contributed to a significant improvement in both survival and patients' quality of life. The multidisciplinary approach, personalised treatments based on tumour characteristics, patient's and disease history, as well as re-definition of treatment goals, aiming at the lowest possible impact on patients' life by replacing aggressive multidrug chemotherapy with single-agent cytotoxic treatment or endocrine ± targeted therapies, have all been the bases of the new treatment paradigm. More recently the development of the international advanced breast cancer (ABC) consensus guidelines have further contributed to this improvement. This review will focus on the major achievements and challenges in the different tumour subtypes and sites, with a focus on future research topics and trends.