When breast cancer recurs or is diagnosed at an advanced stage, treatment is complicated by the diverse nature of the disease, with several molecular subgroups with distinct tumor biology responding differently to different therapies.

For patients with advanced breast cancer, prognosis remains especially suboptimal, primarily because of acquired pharmacologic resistance. Fortunately, several new drugs and drug combinations have recently become available.

Breast cancer is not simply one disease, and the use of more effective therapies that target different tumor markers, such as the cyclin-dependent kinase (CDK)4/6 pathway in estrogen receptor–positive breast cancer, may actually reduce the total cost of care for patients/members and payers.

An open conversation with a patient at this transition point of an MBC diagnosis should stress that, although the disease may be incurable, care can focus on control and hope as long as possible, with a balance for quality of life.

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