Defining the optimal sequence for the systemic treatment of metastatic breast cancer

Metastatic breast cancer is a heterogeneous disease that presents in varying forms, and a growing number of therapeutic options makes it difficult to determine the best choice in each particular situation. When selecting a systemic treatment, it is important to consider the medication administered i...

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Published in:	Clinical & translational oncology Vol. 19; no. 2; pp. 149 - 161
Main Authors:	Mestres, J. A., iMolins, A. B., Martínez, L. C., López-Muñiz, J. I. C., Gil, E. C., de Juan Ferré, A., del Barco Berrón, S., Pérez, Y. F., Mata, J. G., Palomo, A. G., Gregori, J. G., Pardo, P. G., Mañas, J. J. I., Hernández, A. L., de Dueñas, E. M., Jáñez, N. M., Murillo, S. M., Bofill, J. S., Auñón, P. Z., Sanchez-Rovira, P.
Format:	Journal Article
Language:	English
Published:	Cham Springer International Publishing 01-02-2017
Subjects:	Antineoplastic Agents - standards Antineoplastic Agents - therapeutic use Breast Neoplasms - drug therapy Breast Neoplasms - metabolism Breast Neoplasms - pathology Clinical Guides in Oncology Female Humans Medicine Medicine & Public Health Oncology Prognosis Receptor, ErbB-2 - metabolism Receptors, Estrogen - metabolism Receptors, Progesterone - metabolism Targeted therapies Triple-negative tumor Metastatic breast cancer Chemotherapy Hormone therapy HER2 receptor
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Summary:	Metastatic breast cancer is a heterogeneous disease that presents in varying forms, and a growing number of therapeutic options makes it difficult to determine the best choice in each particular situation. When selecting a systemic treatment, it is important to consider the medication administered in the previous stages, such as acquired resistance, type of progression, time to relapse, tumor aggressiveness, age, comorbidities, pre- and post-menopausal status, and patient preferences. Moreover, tumor genomic signatures can identify different subtypes, which can be used to create patient profiles and design specific therapies. However, there is no consensus regarding the best treatment sequence for each subgroup of patients. During the SABCC Congress of 2014, specialized breast cancer oncologists from referral hospitals in Europe met to define patient profiles and to determine specific treatment sequences for each one. Conclusions were then debated in a final meeting in which a relative degree of consensus for each treatment sequence was established. Four patient profiles were defined according to established breast cancer phenotypes: pre-menopausal patients with luminal subtype, post-menopausal patients with luminal subtype, patients with triple-negative subtype, and patients with HER2-positive subtype. A treatment sequence was then defined, consisting of hormonal therapy with tamoxifen, aromatase inhibitors, fulvestrant, and mTOR inhibitors for pre- and post-menopausal patien ts; a chemotherapy sequence for the first, second, and further lines for luminal and triple-negative patients; and an optimal sequence for treatment with new antiHER2 therapies. Finally, a document detailing all treatment sequences, that had the agreement of all the oncologists, was drawn up as a guideline and advocacy tool for professionals treating patients with this disease.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1699-048X 1699-3055
DOI:	10.1007/s12094-016-1520-2