Novel taxane formulations in the treatment of breast cancer: A thought leader discussion and consensus roundtable

Many chemotherapeutic and biologic agents used for advanced breast cancer exhibit activity alone or in combination, but the small number of randomized trials, coupled with the significant heterogeneity of patient and tumor characteristics, have precluded the development of standardized, evidence-based approaches to therapy for advanced disease. This expert faculty roundtable discussion focused on chemotherapy regimens used in pretreated patients. Given the increasing data on taxanes in this setting, a specific need was identified that led to the theme of standard and novel taxanes in this discussion. Numerous factors can predict response and long-term outcome: tumor characteristics like hormone and HER2 receptor status and grade and clinical characteristics like age, functional status, disease-free interval, previous adjuvant therapy, and sites or burden of metastatic disease. The choice of therapeutic agents or combinations, therefore, relies not only on randomized or phase II trial results but also on patient context in relation to these variables. After anthracycline and taxane therapy, agents such as capecitabine, vinorelbine, gemcitabine, and platinum agents and combinations thereof can be active. Taxanes themselves also possess activity, with a dependency on a specific agent and schedule. Albumin-bound paclitaxet has demonstrated superiority to certain taxane agents and schedules and has demonstrated activity after taxane exposure. This discussion highlights basic paradigms by which standard taxanes and albumin-bound paclitaxel can be evaluated as possible therapeutic or investigative options, along with nontaxane agents, emerging biologic agents, and combinations.