Conclusions
Balancing efficacy and QoL is essential for patients with MBC [1,2]. Selection of chemotherapy, endocrine therapy, and targeted agents should be based on current treatment recommendations, clinical trial data, careful assessment of patient and disease characteristics, and very importantly, patient preferences. Sequential monotherapy is the preferred choice for the vast majority of patients who require chemotherapy. Optimal strategies for sequencing therapy are currently unknown. Chemotherapy should be continued until disease progression as long as it is well tolerated. Within the landscape of treatment options, increased attention to patient preference and QoL favors the use of oral chemotherapy agents, such as capecitabine and oral vinorelbine [20]. These agents prolong disease control, provide good tolerability, and reduce the time and cost associated with treatment. However, patient education is fundamental to ensuring appropriate safe use of oral chemotherapeutic agents [20,23]. Oral chemotherapy is also a good option for maintenance treatment to prolong disease control. Metronomic chemotherapy provides multiple-targeted action against breast tumor progression [61]. The convenience and low cost of oral chemotherapeutic agents makes them ideal for metronomic dosing strategies [63]. Metronomic chemotherapy approaches, such as cyclophosphamide ± methotrexate, capecitabine, and oral vinorelbine, have demonstrated efficacy and excellent tolerability in phase II trials and can be considered for some patients with advanced disease [19,63]. Results from large, randomized clinical trials are needed to fully understand the optimal role and positioning for metronomic approaches in the management of patients with MBC.
