Recurrence and metastasis 1. 20-40% of operable breast cancers eventually develop recurrence and metastasis, and 2. about 5% of breast cancer patients have distant metastasis at the time of initial diagnosis. Common sites of recurrence and metastasis Strategies to improve the survival of patients with metastatic breast cancer “Treat breast cancer as a chronic disease” (Sayuri Hirota, Japanese Chinese) Manage breast cancer patients throughout the course of treatment The concept of treatment by total management is based on 1. Most patients do not eventually die from breast cancer 2. For some patients with metastatic disease, they can achieve Complete remission and long-term survival 3. better prognosis and longer disease-free survival 4. more treatment methods 5. rapid research progress 6. treatment resistance → change of regimen 7. progress → change of drug For HR-positive metastatic breast cancer, making it a chronic disease has become a reality For HR-negative metastatic breast cancer, managing it as a chronic disease has gone from theory to practice The essence of treating chronic disease is to improve symptoms and prolong survival. Prolonging the survival of MBC patients requires physician management throughout the entire process! Recurrence or metastasis The aim of treatment: prolonging survival and improving quality of life, not curative Treatment regimen: prioritize the treatment regimen with the least toxic side effects possible Endocrine therapy is preferred to chemotherapy (when the situation permits) The basic principle of chemotherapy: long flow of water, prolonging life Single agent sequential: encyclopedics, paclitaxel, antimetabolites (capecitabine, etc.) Combination regimen: FAC, FEC, AC, AT, TAC, NP, etc. NP, etc. Principles of drug selection: 1. Encyclines → paclitaxel → antimetabolites (capecitabine) → platinum 2. Selection according to the patient’s comorbid diseases (hypertension, coronary artery disease, etc.) Targeted therapy HER-2-positive patients can benefit from either Herceptin alone or in combination with chemotherapy For receptor-positive patients, endocrine therapy is recommended first The optimal duration of use of targeted therapy is unclear (1 year, 2 years) ……)