Moderator Adam M. Brufsky, MD, PhD, introduces a panel discussion focused on the treatment of metastatic and locally advanced breast cancer in community-based clinics. The discussion includes expert perspective from Sara Hurvitz, MD, Eleftherios P. Mamounas, MD, Hope S. Rugo, MD, and Dialecti Voudouris, MD.

At this point, there is not a standard frontline chemotherapy for every patient with metastatic breast cancer, Voudouris notes. The best treatment to administer depends on biomarkers, HER2, HR, and other patient characteristics. Additionally, each treatment and its side effects should be discussed with the patient, Voudouris says.

For patients with triple-negative breast cancer, anthracyclines and taxanes represent standard frontline options. However, if a patient has already received these agents in the adjuvant setting, capecitabine or another taxane are reasonable options, Voudouris believes.

In the phase III CALGB 40502, nab-paclitaxel at 150-mg/m² or ixabepilone in combination with paclitaxel was explored for patients with chemotherapy-naive metastatic breast cancer. Bevacizumab was initially given to all patients but became optional in 2011, notes Rugo. An early interim analysis, suggested that ixabepilone was inferior to weekly paclitaxel. This was followed by a second interim analysis that demonstrated that weekly paclitaxel and nab-paclitaxel were equivalent, resulting in the study being stopped early.

The differences seen between the drugs may have been a result of dosing, Rugo notes. In general, the ixabepilone dose was too low, as a result of side effects at higher doses. Additionally, the 150 mg/m² dose of nab-paclitaxel was too high, resulting in side effects, dose reductions, and treatment discontinuation, remarks Rugo.