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Breast cancer is a significant cause of morbidity and mortality among women. In the United States, it is the most common malignancy among women. It is estimated that approximately 194,280 new cases of invasive breast cancer will have occurred in the United States in 2009 (1). Although lung cancer has surpassed breast cancer as the leading cause of cancer death among women, nearly 40,200 deaths are expected to occur from breast cancer alone in 2009 (1).

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Since the 1970s, advances in primary and adjuvant systemic therapies have substantially improved both survival and quality of life in patients with newly diagnosed, early, and locally advanced breast cancer. In spite of these advances, approximately 10 to 60% of patients with initial localized breast cancer will suffer a systemic relapse. Furthermore, metastatic disease is diagnosed at the time of presentation in 3 to 6% of patients, but can be as high as 10 to 12% depending on the series (1,2). Bone is the most common site of first distant relapse; other common sites of metastases include lymph nodes, lung, liver, and less frequently brain. The 5-year survival rate for localized breast cancer is 97%, but for women with metastatic disease, this rate is only 17 to 28% (1,2). As is true with cancer in general, the clinical course for patients with metastatic breast cancer varies from patient to patient, but as a group, patients with metastatic breast cancer (MBC) have a median survival of 23 months (3). Patients with bone-only disease tend to live longer than patients with visceral involvement. Untreated patients with MBC will have a median overall survival time of 9 to 12 months. With chemotherapy, the mean survival time is 21 months for patients with visceral disease, and is as long as 60 months for patients with bone-only disease. Survival and response to therapy are affected by several factors, including estrogen receptor (ER), progesterone receptor (PR), and HER2/neu receptor status; performance status; site of disease; number of disease sites; and duration of disease-free interval.

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The therapeutic objectives and approach to patients with advanced breast cancer is distinct from that of those patients with early-stage disease. Treatment for MBC is triaged to endocrine therapy, biological therapy, or chemotherapy, depending on the hormonal and HER-2/neu receptor status of the tumor and the severity of the symptoms and site and extent of disease. Systemic treatment prolongs survival, provides palliation of symptoms, and enhances quality of life, but in general terms is not considered curative; therefore, a discussion regarding goals of care is imperative between the patient and treating oncologist. Cure in MBC is rare; less than 2% of patients with chemotherapy-naïve MBC may remain disease-free after anthracycline-containing therapy. It is possible to prolong the median survival of patients with MBC as much as 18 to 36 months. In a review of the survival of patients with recurrent breast cancer, Giordano ...

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