New concepts in breast cancer therapy.

Breast cancer is a common disease in the community. Its incidence is increasing but its mortality is falling. New therapeutic approaches based on a biological understanding of the disease are being investigated to improve the outcome. These include the areas of chemoprevention and therapy in the adjuvant and advanced settings, and some derive from a better understanding of the biology of breast cancer. New prognostic indicators are being studied to enable adjuvant chemotherapy to be directed towards those most likely to benefit. Trastuzumab was the first of the new targeted therapies to be introduced into routine practice. Several other agents targeting a variety of receptors and cell pathways, such as the epidermal growth factor receptor, the vascular epithelial growth factors and various intracellular tyrosine kinase mediated pathways, are under investigation. Increasing attention is being placed on evidence-based supportive care, both for control of symptoms such as hot flushes and for psychosocial problems such as anxiety and depression.