Metastatic Breast Cancer Epidemiology and Management With a Focus on Taxanes

Diana Donovan

metastasis, breast cancer, breast cancer treatment
CJON 2013, 17(1), 5-8. DOI: 10.1188/13.CJON.S1.5-8

Although considerable treatment advances have been made since the early 2000s, metastatic breast cancer (MBC) continues to provide challenges for patients and healthcare providers. The responsibilities of nurses regarding the management of MBC are extensive. Among other things, nurses must provide patient education, understand treatment administration, and have the ability to perform patient assessments, as well as identify and manage symptoms. The taxanes paclitaxel, docetaxel, and nab-paclitaxel are a class of microtubule-stabilizing agents that are highly active against MBC but have many differences among them (e.g., formulation, administration, efficacy, tolerability profiles). Understanding those differences will aid in improving the overall patient experience. This supplement provides a historical overview of taxanes, examines the differences in their administration, and defines their efficacy and safety profiles and effects on patient quality of life. In addition, methods for assessing taxane-induced neuropathy are discussed from the nursing perspective, and treatment considerations for older adult patients with MBC are provided.

Jump to a section


    American Cancer Society. (2011). Global facts and figures (2nd ed.). Atlanta, GA: Author.
    American Cancer Society. (2012). Cancer facts and figures 2012. Atlanta, GA: Author.
    Bergh, J., Jönsson, P.E., Lidbrink, E.K., Trudeau, M., Eiermann, W., Brattström, D., … Henriksson, R. (2012). FACT: An open-label randomized phase III study of fulvestrant and anastrozole in combination compared with anastrozole alone as first-line therapy for patients with receptor-positive postmenopausal breast cancer. Journal of Clinical Oncology, 30, 1919-1925.
    Berry, D.A., Cronin, K.A., Plevritis, S.K., Fryback, D.G., Clarke, L., Zelen, Z., … for the Cancer Intervention and Surveillance Modeling Network (CISNET) Collaborators. (2005). Effect of screening and adjuvant therapy on mortality from breast cancer. New England Journal of Medicine, 353, 1784-1792.
    Bettelheim, F.A., Brown, W.H., Campbell, M.K., & Farrell, S.O. (2010). Organic chemistry. In F.A. Bettelheim, W.H. Brown, M.K. Campbell, & S.O. Farrell (Eds.), Introduction to organic and biochemistry (7th ed., pp. 307-322). Belmont, CA: Brooks/Cole, Cengage Learning.
    Bishop, J.F., Dewar, J., Toner, G.C., Smith, J., Tattersall, M.H.N., Olver, I.N., … Canetta, R. (1999). Initial paclitaxel improves outcome compared with CMFP combination chemotherapy as front-line therapy in untreated metastatic breast cancer. Journal of Clinical Oncology, 17, 2355-2364.
    Bonneterre, J., Thürlimann, B., Robertson, J.F.R., Krzakowski, M., Mauriac, L., Koralewski, P., … von Euler, M. (2000). Anastrozole versus tamoxifen as first-line therapy for advanced breast cancer in 668 postmenopausal women: Results of the Tamoxifen or Arimidex Randomized Group Efficacy and Tolerability study. Journal of Clinical Oncology, 18, 3748-3757.
    Bristol-Myers Squibb. (2011). Taxol® (paclitaxel) [Prescribing information]. Retrieved from
    Celgene Corporation. (2012). Abraxane® (nab-paclitaxel) [Prescribing information]. Retrieved from
    Chia, S., Gradishar, W., Mauriac, L., Bines, J., Amant, F., Federico, M., … Piccart M. (2008). Double-blind, randomized placebo controlled trial of fulvestrant compared with exemestane after prior nonsteroidal aromatase inhibitor therapy in postmenopausal women with hormone receptor-positive, advanced breast cancer: Results from EFFECT. Journal of Clinical Oncology, 26, 1664-1670. doi:10.1200/JCO.2007.13.5822
    Curtis, C., Shah, S.P., Chin, S.F., Turashvili, G., Rueda, O.M., Dunning, M.J., … Aparicio, S. (2012). The genomic and transcriptomic architecture of 2,000 breast tumors reveals novel subgroups. Nature, 486, 346-352. doi:10.1038/nature10983
    Early Breast Cancer Trialists' Collaborative Group. (2005). Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: An overview of the randomised trials. Lancet, 365, 1687-1717. doi:10.1016/S0140-6736(05)66544-0
    Gradishar, W.J., Krasnojon, D., Cheporov, S., Makhson, A.N., Manikhas, G.M., Clawson, A., & Bhar, P. (2009). Significantly longer progression-free survival with nab-paclitaxel compared with docetaxel as first-line therapy for metastatic breast cancer. Journal of Clinical Oncology, 27, 3611-3619. doi:10.1200/JCO.2008.18.5397
    Gradishar, W.J., Krasnojon, D., Cheporov, S.V., Makhson, A.N., Manikhas, G.M., Clawson, A., & Iglesias, J. (2011). Nab-paclitaxel versus docetaxel for the first-line treatment of metastatic breast cancer: Final overall survival (OS) analysis of a randomized phase 2 trial [Poster 275]. Poster presented at the American Society of Clinical Oncology Annual Meeting, Chicago, IL.
    Gradishar, W.J., Tjulandin, S., Davidson, N., Shaw, H., Desai, N., Bhar, P., … O'Shaughnessy, J. (2005). Phase III trial of nanoparticle albumin-bound paclitaxel compared with polyethylated castor oil-based paclitaxel in women with breast cancer. Journal of Clinical Oncology, 23, 7794-7803. doi:10.1200/JCO.2005.04.937
    Hausheer, F.H., Schilsky, R.L., Bain, S., Berghorn, E.J., & Lieberman, F. (2006). Diagnosis, management, and evaluation of chemotherapy-induced peripheral neuropathy. Seminars in Oncology, 33, 15-49. doi:10.1053/j.seminoncol.2005.12.010
    Howlader, N., Noone, A.M., Krapcho, M., Neyman, N., Aminou, R., Altekruse, S.F., … Cronin, K.A. (Eds.). (2012). SEER cancer statistics review, 1975-2009. Retrieved from
    Hurtig, J. (2010). Managing patients with advanced and metastatic breast cancer: Taxanes and epothilones. Clinical Journal of Oncology Nursing, 14, 313-323. doi:10.1188/10.CJON.313-323
    Mouridsen, H., Gershanovich, M., Sun, Y., Pérez-Carrión, R., Boni, C., Monnier, A., … Bhatnagar, A. (2003). Phase III study of letrozole versus tamoxifen as first-line therapy of advanced breast cancer in postmenopausal women: Analysis of survival and update of efficacy from the International Letrozole Breast Cancer Group. Journal of Clinical Oncology, 21, 2101-2019. doi:10.1200/JCO.2003.04.194
    Nabholtz, J.M., Falkson, C., Campos, D., Szanto, J., Martin, M., Chan, S., … Poulliart, P. (1993). Docetaxel and doxorubicin compared with doxorubicin and cyclophosphamide as first-line chemotherapy for metastatic breast cancer: Results of a randomized, multicenter, phase III trial. Journal of Clinical Oncology, 21, 968-975.
    National Comprehensive Cancer Network. (2012). NCCN Clinical Practice Guidelines in Oncology: Breast cancer [v.3.2012]. Retrieved from
    O'Shaughnessy, J. (2005). Extending survival with chemotherapy in metastatic breast cancer. Oncologist, 10(Suppl. 3), 20-29. doi:10.1634/theoncologist.10-90003-20
    Pachman, D.R., Barton, D.L., Watson, J.C., & Loprinzi, C.L. (2011). Chemotherapy-induced peripheral neuropathy: Prevention and treatment. Clinical Pharmacology and Therapeutics, 90, 377-387. doi:10.1038/clpt.2011.115
    Paridaens, R.J., Dirix, L.Y., Beex, L.V., Nooij, M., Cameron, D., Cufer, T., … Therasse, P. (2008). Phase III study comparing exemestane with tamoxifen as first-line hormonal treatment of metastatic breast cancer in postmenopausal women: The European Organisation for Research and Treatment of Cancer Breast Cancer Cooperative Group. Journal of Clinical Oncology, 30, 4883-4890. doi:10.1200/JCO.2007.14.4659
    Perey, L., Paridaens, R., Hawle, H., Zaman, K., Nolé, F., Wildiers, H., … Thürlimann, B. (2007). Clinical benefit of fulvestrant in postmenopausal women with advanced breast cancer and primary or acquired resistance to aromatase inhibitors: Final results of phase II Swiss Group for Clinical Cancer Research trial (SAKK 21/00). Annals of Oncology, 18, 64-69. doi:10.1093/annonc/mdl341
    Ribeiro, J.T., Macedo, L.T., Curigliano, G., Fumagalli, L., Locatelli, M., Dalton, M., … Goldhirsch, A. (2012). Cytotoxic drugs for patients with breast cancer in the era of targeted treatment: Back to the future? Annals of Oncology, 23, 547-555. doi:10.1093/annonc/mdr382
    sanofi-aventis. (2010). Taxotere® (docetaxel) [Prescribing information]. Retrieved from
    Schneider, B.P., Zhao, F., Wang, M., Stearns, V., Martino, S., Jones, V., … Sparano, J.A. (2012). Neuropathy is not associated with clinical outcomes in patients receiving adjuvant taxane-containing therapy for operable breast cancer. Journal of Clinical Oncology, 20, 3051-3057. doi:10.1200/JCO.2011.39.8446
    U.S. Food and Drug Administration. (2012). Drugs@FDA: FDA approved drug products. Retrieved from
    Von Minckwitz, G., Schwedler, K., Schmidt, M., Barinoff, J., Mundhenke, C., Cufer, T., … Loibl, S. (2011). Trastuzumab beyond progression: Overall survival analysis of the GBG 26/BIG 3-05 phase III study in HER2-positive breast cancer. European Journal of Cancer, 47, 2273-2281. doi:10.1016/j.ejca.2011.06.021
    Wicklin Gillespie, T. (2005). Implementation of the NCCN practice guidelines: Anemia and neutropenia. Advanced Studies in Nursing, 3, 300-309.