Table 1  Selection of cytostatic agents for use in metastatic breast cancer (licensing status in August 2019).

Drug	Area of use	Toxicity spectrum	Comment
A = anthracyclines, T = taxanes
Doxorubicin	I. v. therapy, 3-weekly or weekly Especially first line in HER2-neg., HR-pos. and triple-negative (ER/PR/HER2- breast Ca.) (TNBC)	Alopecia, cardiotoxicity, myelosuppression, mucositis, nausea and vomiting	LVEF due to adjuvant anthracycline therapy reduced Note cumulative A dose
Epirubicin	I. v. therapy, 3-weekly or weekly Especially first line in HER2-neg., HR-pos. and in TNBC	Alopecia, myelosuppression, cardiomyopathy, but less cardiotoxicity than doxorubicin, nausea and vomiting	LVEF due to adjuvant anthracycline therapy reduced Note cumulative A dose
Mitoxantrone	I. v. therapy Especially later lines in HER2-neg., HR-pos. and in TNBC	Alopecia, nausea and vomiting
Docetaxel	I. v. therapy, 3-weekly Especially first line in HER2-neg., HR-pos. and in TNBC, in HER2-pos. in combination with anti-HER2 therapy	Alopecia, diarrhoea, mucositis, dose-limiting myelosuppression, nausea and vomiting, dose-dependent peripheral neuropathy (at the dosage 100 mg/m 2 as monotherapy in 2 – 30% of cases [grade 3 – 4])	Hypersensitivity reactions more seldom than with paclitaxel
Paclitaxel	I. v. therapy, preferably weekly Especially first line in HER2-neg., HR-pos. and in TNBC, in HER2-pos. in combination with anti-HER2 therapy	Dose-limiting myelosuppression, dose-dependent and dose-limiting cumulative peripheral polyneuropathies (3-weekly dosage 175 mg/m 2 : 2 – 13%, weekly dosage 80 mg/m 2 : 17 – 30% grade 3 – 4) Allergic reactions because of cremophor	Anti-allergic premedication required. No direct correlation between dose and anti-tumour effect. Combination with bevacizumab possible.
nab -Paclitaxel	I. v. therapy, 3-weekly or weekly in adult patients in whom the first-line treatment of metastatic disease has failed and for whom standard anthracycline-containing therapy is not indicated (in HER2-pos in combination with anti-HER2 therapy)	Alopecia, myelosuppression, peripheral polyneuropathy in 9 – 22% of cases (grade 3 – 4) 5	No premedication required after anthracycline pretreatment, also after taxane pretreatment and treatment-free interval of more than 12 months
Pegylated liposomal doxorubicin	I. v. therapy, 3-weekly or weekly as first-line in patients with increased cardiac risk and after A pretreatment and after A and T pretreatment	Alopecia, myelosuppression, PPE	Lower cardiotoxicity than with non-liposome encapsulated doxorubicin
Liposomal doxorubicin	I. v. therapy, 3-weekly or weekly after anthracycline pretreatment, with increased cardiac risk	Alopecia, nausea and vomiting	Lower cardiotoxicity than with non-liposome encapsulated doxorubicin
Capecitabine	P. o. first-line and after A pretreatment and after A and T pretreatment	PPE, nausea and vomiting	After A pretreatment and after A and T pretreatment. Combination with bevacizumab possible
Vinorelbine	I. v. or p. o. therapy after A and T pretreatment	Myelosuppression, dose-dependent neurotoxicity	After A and T pretreatment
Eribulin	I. v. therapy after A and T pretreatment	Alopecia, myelosuppression, peripheral neuropathy, nausea and vomiting	After A and T pretreatment
Carboplatin	I. v. therapy, weekly or 3/4-weekly TNBC with BRCA mutation TNBC with BRCA mutation Possibly in combination with gemcitabine (warning: off label use)	Nausea and vomiting
Cisplatin	I. v. therapy, 3-weekly in TNBC in combination with gemcitabine (warning: off label use)	Alopecia, myelosuppression, nephrotoxicity, neurotoxicity, ototoxicity, nausea and vomiting
Gemcitabine	I. v. therapy, 3/4-weekly in combination with a taxane after adjuvant A therapy in TNBC in combination with cisplatin or carboplatin	Flu-like symptoms and peripheral oedema, myelosuppression