Breast cancer (metastatic).

INTRODUCTION Median survival from metastatic breast cancer is 12 months without treatment, but young people can survive up to 20 years with the disease, whereas in other metastatic cancers this would be considered unusual. METHODS AND OUTCOMES We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of first-line hormonal treatment? What are the effects of second-line hormonal treatment in women who have not responded to tamoxifen? What are the effects of first-line chemotherapy? What are the effects of first-line chemotherapy in combination with a monoclonal antibody? What are the effects of second-line chemotherapy? What are the effects of treatments for bone metastases? What are the effects of treatments for spinal cord metastases? What are the effects of treatments for cerebral or choroidal metastases? We searched: Medline, Embase, The Cochrane Library and other important databases up to June 2006 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). RESULTS We found 63 systematic reviews, RCTs, or observational studies that met our inclusion criteria. CONCLUSIONS In this systematic review we present information relating to the effectiveness and safety of the following interventions: anthracycline-based non-taxane combination chemotherapy regimens; bisphosphonates; capecitabine or semisynthetic vinca alkaloids for anthracycline-resistant disease; chemotherapy plus monoclonal antibody (trastuzumab); classical non-taxane combination chemotherapy; combined gonadorelin analogues plus tamoxifen; hormonal treatment with antioestrogens (tamoxifen) or progestins; intrathecal chemotherapy; non-anthracycline-based regimens; non-taxane combination chemotherapy; ovarian ablation; radiation sensitisers; radiotherapy (alone, or plus appropriate analgesia, or plus high-dose corticosteroids); selective aromatase inhibitors; chemotherapy (standard, or high dose); surgical resection; tamoxifen; and taxane-based combination chemotherapy.

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