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Chemotherapy and hormonal therapy are the main treatment options for metastatic breast cancer. Radiation therapy is not generally offered to patients with metastatic breast cancer. Radiation therapy is a local treatment, which is effective only locally where the radiation beam hits the body, but chemotherapy circulates in the bloodstream and travel to most of the organs and is effective in controlling the disease in most parts of the body (brain is a notable exception). Unlike adjuvant therapy, the treatment of metastatic breast cancer with chemotherapy does not have a set pattern and fixed number of cycles. The treatment length will largely depend upon the response of the tumor to the treatment and side effects from the chemotherapy. Chemotherapy may also be given as a neoadjuvant therapy. Neoadjuvant therapy involves treatment prior to surgery with the idea of decreasing the size of the tumor. This is especially used the patient has a large tumor, or the tumor infiltrates the skin of the breast. After successful neoadjuvant
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chemotherapy it would be much easier for the physician to do the surgical procedure. Sometimes the neoadjuvant chemotherapy can be very effective so that the whole tumor may disappear. Even if the tumor has completely disappeared, these patients would still need surgery and axillary node dissection. Neoadjuvant chemotherapy may also give idea regarding chemo-sensitivity of the tumor (how well the tumor responds to the chemotherapy) and this may influence future choice of the chemotherapy drugs. Giving chemotherapy prior to surgery however has not shown to have any survival benefit for breast cancer compared to chemotherapy after surgery. In the adjuvant setting a combination of chemotherapy given together usually works better than single drug used alone. Metastatic breast cancer is sometimes treated with single agent chemotherapy drug or combination of chemotherapy drugs depending mainly on prior chemotherapy exposures. The most commonly used combinations for breast cancer include:
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