An assessment of current achievements in the systemic management of breast cancer.

Over the past twenty years, breast cancer has come to be much more commonly regarded and treated as a systemic disease. Conventional chemotherapy and endocrine therapy used according to schedules that are tolerable to patients are generally effective and often induce worthwhile responses; nevertheless, the responses in general have a median duration of less than a year, and these therapies are rarely if ever curative. Continued efforts to use available agents with mere modifications of schedule and intensity seem unlikely to substantially improve upon the modest success already achieved. Rather, we desperately need radically new schedules, new agents (especially non-myelosuppressive agents), and new approaches (e.g. monoclonal antibody targeting of drugs, toxins, or radionuclides, perhaps combined with tumor sensitizing agents such as heat). It is our hope that consideration of some of these issues will encourage others to be bolder in devising the next generation of clinical trials.