Clinical Journal of Oncology Nursing • Supplement to Volume 13, Number 1 • New Options for Metastatic Breast Cancer 11
Debra K. Frye, RN, BSN, OCN®, CCRP,
Suzanne M. Mahon, RN, DNSc, AOCN®, APNG,
and Frances M. Palmieri, RN, MSN, OCN®, CCRP
Patients with advanced breast cancer are living longer and receiving multiple lines of chemotherapy; however, they even-
tually develop resistance to the agents. Two more agents have been approved for the treatment of breast cancer and will
provide additional treatment options for such patients. Ixabepilone represents a new class of cytotoxic chemotherapy
called the epothilones. Ixabepilone was approved for use as a single agent for the treatment of metastatic breast cancer
resistant to taxanes, anthracyclines, and capecitabine, as well as in combination with capecitabine for disease refractory
to taxanes and anthracyclines. Bevacizumab, a monoclonal antibody targeting vascular endothelial growth factor, was ap-
proved for first-line treatment of HER2-negative metastatic breast cancer in combination with paclitaxel. Understanding
the efficacy, toxicity, and administration of the agents is crucial for oncology nurses to optimally educate and treat patients
with advanced breast cancer.
a multitude of active agents, the treatment of MBC is palliative,
and because patients are living longer, they eventually develop
resistance. Those factors underscore the need for more effec-
tive upfront therapies. Two more agents have been approved for
breast cancer treatment to help address that need. Ixabepilone,
approved by the U.S. Food and Drug Administration (FDA) in
October 2007 for the treatment of resistant disease, represents
a new class of cytotoxic chemotherapy, the epothilones. Beva-
cizumab, a monoclonal antibody targeting vascular endothelial
growth factor (VEGF), was approved in 2004 for the treatment
of colorectal cancer and in 2006 for non-small cell lung cancer.
In February 2008, it also was approved for the upfront treatment
of MBC. Understanding the efficacy, toxicity, and administration
of the agents is crucial for oncology nurses to optimally educate
and treat patients with advanced breast cancer.
New Options for Metastatic Breast Cancer
At a Glance
F Metastatic breast cancer responds to multiple types of
therapies, but drug resistance remains a clinical challenge.
F Ixabepilone, a first-in-class epothilone, recently was ap-
proved for use in patients with resistant breast cancer.
F Bevacizumab has been approved for use in combination with
paclitaxel for upfront use in metastatic breast cancer.
Debra K. Frye, RN, BSN, OCN®, CCRP, is a research nurse manager in the
Department of Breast Medical Oncology at the University of Texas M.D.
Anderson Cancer Center in Houston; Suzanne M. Mahon, RN, DNSc,
AOCN®, APNG, is a clinical professor in the Department of Internal
Medicine and in the School of Nursing at Saint Louis University in St.
Louis, MO; and Frances M. Palmieri, RN, MSN, OCN®, CCRP, is a clinical
nurse specialist manager in the breast clinic and breast cancer program
at Mayo Clinic in Jacksonville, FL. Frye is a member of the speakers
bureau for Bristol-Myers Squibb Company and Genomic Health and is a
consultant for Bristol-Myers Squibb Company. Publication of this supple-
ment is made possible through an unrestricted educational grant from
Bristol-Myers Squibb. Mention of specific products and opinions related
to those products do not indicate or imply endorsement by the Clinical
Journal of Oncology Nursing or the Oncology Nursing Society. (Submitted
September 2008. Accepted for publication October 22, 2008.)
Digital Object Identifier:10.1188/09.CJON.S1.11-18
atients with advanced breast cancer are living lon-
ger and receiving multiple lines of chemotherapy
during the course of their disease. A survey of 105
oncologists found that the median number of regi-
mens a patient with metastatic breast cancer (MBC)
received was 4, with a range of 1–10 (Seidman, 2006). Despite
Ixabepilone represents a novel class of cytotoxic chemother-
apy, the epothilones. Epothilones exert their cytotoxic effect by
binding to and stabilizing microtubules (Goodin, Kane, & Rubin,
2004), which are cellular components that have several functions
crucial to cell division and growth. In a manner similar to taxanes,
when bound to microtubules, epothilones disrupt their function
(Goodin et al.). Evidence exists that epothilones have activity in
taxane-resistant cancer cells (Goodin et al.). Other epothilones
are in development, but ixabepilone is the first agent in the class
to receive FDA approval. It is approved for use as a single agent
for the treatment of MBC resistant to taxanes, anthracyclines,
and capecitabine, as well as in combination with capecitabine for
disease refractory to taxanes and anthracyclines.