• If the metastasic disease is not immediately life-threatening or doesn't involve such critical internal organs as 
  the liver, hormonal management is usually tried before starting chemotherapy . This may involve tamoxifen or 
  removal of the ovaries for premenopausal patients, and progestins , androgens , aminoglutethimide or
  tamoxifen for postmenopausal patients. Hormonal manipulation may be especially useful for those with
  predominantly bone metastases.
• If metastases involve vital organs or are life-threatening, chemotherapy combinations similar to those used in 
  earlier stages are given. Again, the risk of doxorubicin-induced cardiac toxicity may limit the amount of drug 
  that can be given.

Five-Year Survival  10 percent 

Investigational
• All patients are candidates for clinical trials , which may involve new drugs in Phase I, II or III trials, new 
  biologic agents, autologous bone marrow transplantation (ABMT), treatment with monoclonal antibodies , or 
  high-dose chemotherapy with growth factor (such as G-CSF) support. The use of ABMT for advanced 
  disease shows some early promise (20 to 25 percent survival after two years) but the final role of ABMT is 
  uncertain.