Liver metastases: Can our understanding of their biology and prognostic value contribute to a strategy for optimum therapeutic management?
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Breast cancer is most likely to recur in soft tissue, liver, lungs and bone. The development of visceral disease, in particular liver disease, carries a poorer prognosis than the development of soft tissue or bony disease. Traditionally, liver metastases were believed to respond more poorly to hormonal approaches than other metastatic sites; although many studies of hormonal agents document a response in liver metastases in at least a proportion of the patients treated. Chemotherapeutic agents are generally considered the first-line of approach for women who have developed liver metastases from breast cancer, however. No well designed randomised studies have yet been carried out to compare the effects of various chemotherapeutic approaches using response in liver as a specific outcome. Many practitioners believe, even if this belief is not well documented in studies, that anthracyclines are more likely to produce shrinkage of liver metastases than some of the more traditional regimens such as cyclophosphamide/methotrexate/5-fluorouracil. More recently, it has been suggested from phase II data that liver metastases may respond more rapidly and completely to some of the newer agents such as the taxoids. Even in the setting of very aggressive chemotherapy, however, liver metastases retain their poor prognosis. Both disease characteristics and systemic adjuvant therapy have been linked to the site of recurrence of disease and considerable research into the molecular mechanisms mediating the distribution of metastases has been carried out. Despite the poor prognosis for patients with liver metastases, many new avenues are currently being explored to better understand and control this situation and, perhaps, to lead to the development of new treatment strategies for patients with this disease.
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