The armamentarium for the treatment of metastatic breast cancer is increasing with the introduction of newer chemotherapeutic agents and the development of molecular targeted therapies. The clinical utility of anthracyclines in advanced breast cancer has been limited by significant adverse events; therefore the taxanes are increasingly used in the metastatic setting. Trastuzumab with a taxane as first-line therapy is now standard of care for patients with human epidermal growth factor receptor 2 (HER2)-positive metastatic breast cancer. Other targeted therapies, including the antiangiogenesis agents such as bevacizumab, are being investigated both as monotherapy and in combination regimens. While the number of available agents is growing rapidly, challenges remain concerning appropriate dose, schedule, treatment duration and management of drug resistance. This paper reviews recent data regarding the established and investigational medical treatments for endocrine-refractory metastatic breast cancer, and presents treatment recommendations.

Long-term outcomes and hence the role of adjuvant therapy in patients with small (<1 cm), node-negative breast cancer remain unclear. This study's objective was to evaluate whether human epidermal growth factor receptor (HER)-2 status is an independent, poor prognostic marker in patients with these tumors and to identify a subgroup of patients with these small tumors who might benefit from adjuvant systemic therapy. All patients with a diagnosis of a node-negative breast tumor measuring <1 cm and available HER-2 test results between January 1, 2001, and December 31, 2005, at the three Mayo Clinic sites were identified. Clinicopathologic data were compared in three groups: HER-2 ؊ , HER-2 ؉ , and triple-negative (TN) tumors. Of the 421 tumors identified, 364 (86.5%) were HER-2 ؊ , 28 (6.7%) were HER-2 ؉ , and 29 (6.9%) were TN. The median follow-up time was 1,015 days (range, 1-2,549 days). Groups were balanced in terms of patient age and tumor histology. Eleven patients with HER-2؊ tumors (3.0%), seven with HER-2 ؉ tumors (25.0%), and eight with TN tumors (27.6%) received adjuvant chemotherapy. Follow-up data were available for 357, 28, and 28 patients in the three groups, respectively. Death rates in the three groups were 6.4% (23 of 357) (one recurrencerelated death), 0% (0 of 28), and 7.1% (2 of 28) (one recurrence-related death), respectively. During followup, the tumor recurred in nine patients: four were HER-2 ؊ tumors (1.1%), two were HER-2 ؉ tumors (7.1%), and three were TN tumors (10.7%). Patients with small, node-negative breast tumors have an excellent prognosis, but HER-2 ؉ and TN tumors appear to have a higher recurrence rate, warranting consideration for broad use and optimization of systemic adjuvant treatments. The Oncologist

Choriocarcinoma syndrome is a rare clinical entity with advanced, high volume choriocarcinomatous tumors and markedly elevated B-hCG (>50,000 IU/L). Recognition is important because the diagnosis of this syndrome identifies poor prognosis without mortality-proven management options. We present a case of a male in his twenties with metastatic choriocarcinoma who developed choriocarcinoma syndrome acutely after chemotherapy commencement. The patient deceased after hypoxic respiratory failure due to diffuse alveolar hemorrhage as a result of death of vascular tumors. While the prognosis for early diagnosis and treatment is excellent, the prognosis for late diagnosis is grim. Unfortunately, despite surgical or chemotherapeutic intervention, this syndrome has poor outcome.