The role of maintenance strategies in breast cancer
Maintenance treatment is generally administered to patients without progression after an initial chemotherapy regimen of standard duration, with the aim of increasing the time to progression of disease. The aims of this strategy include prolongation of survival with good quality of life and symptom control. The duration of the treatment is generally based on patient responsiveness and individual tolerability as well as physician preferences. As breast cancer is a heterogeneous disease with different biological characteristics, the strategy of maintenance therapy may be adapted accordingly. Metronomic chemotherapy has been investigated particularly in advanced hormone receptor negative breast cancer and resulted as an interesting and valid alternative for maintenance therapy in this setting of patients. Recent results of a meta-analysis of randomized trials with maintenance chemotherapy showed a slight benefit in the overall survival and a more significant benefit in the progression free survival. However, this benefit should be balanced with toxicities and the use of the regimen with the best risk-benefit ratio should be preferred. Communication between the oncologist and the patient may help to determine the appropriate treatment choice and the correct duration of the treatment on an individual basis.