International guidelines for management of metastatic breast cancer: can metastatic breast cancer be cured?
A distinctive subset of metastatic breast cancer (MBC) is oligometastatic disease, which is characterized by single or few detectable metastatic lesions. The existing treatment guidelines for patients with localized MBC include surgery, radiotherapy, and regional chemotherapy. The European School of Oncology-Metastatic Breast Cancer Task Force addressed the management of these patients in its first consensus recommendations published in 2007. The Task Force endorsed the possibility of a more aggressive and multidisciplinary approach for patients with oligometastatic disease, stressing also the need for clinical trials in this patient population. At the sixth European Breast Cancer Conference, held in Berlin in March 2008, the second public session on MBC guidelines addressed the controversial issue of whether MBC can be cured. In this commentary, we summarize the discussion and related recommendations regarding the available therapeutic options that are possibly associated with cure in these patients. In particular, data on local (surgery and radiotherapy) and chemotherapy options are discussed. Large retrospective series show an association between surgical removal of the primary tumor or of lung metastases and improved long-term outcome in patients with oligometastatic disease. In the absence of data from prospective randomized studies, removal of the primary tumor or isolated metastatic lesions may be an attractive therapeutic strategy in this subset of patients, offering rapid disease control and potential for survival benefit. Some improvement in outcome may also be achieved with optimization of systemic therapies, possibly in combination with optimal local treatment.
Pagani
Olivia
O
Oncology Institute of Southern Switzerland, Ospedale Italiano, Viganello, Lugano, Switzerland.
Senkus
Elzbieta
E
Wood
William
W
Colleoni
Marco
M
Cufer
Tanja
T
Kyriakides
Stella
S
Costa
Alberto
A
Winer
Eric P
EP
Cardoso
Fatima
F
D000818:Animals; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use*; D001859:Bone Neoplasms / Q000628:therapy; D001943:Breast Neoplasms / Q000188:drug therapy / Q000276:immunology / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D017115:Catheter Ablation; D017024:Chemotherapy, Adjuvant; D002986:Clinical Trials as Topic; D003226:Congresses as Topic; D003245:Consensus Statements as Topic; D004305:Dose-Response Relationship, Drug; D055088:Early Detection of Cancer; D005060:Europe; D005260:Female; D020869:Gene Expression Profiling; D006801:Humans; D007166:Immunosuppressive Agents / Q000378:metabolism; D033183:Interdisciplinary Communication; D007391:International Cooperation; D008113:Liver Neoplasms / Q000556:secondary / Q000601:surgery; D008175:Lung Neoplasms / Q000556:secondary / Q000601:surgery; D009367:Neoplasm Staging; D009360:Neoplastic Cells, Circulating; D015588:Observer Variation; D010348:Patient Care Team; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D018714:Radiotherapy, Adjuvant; D015996:Survival Rate
D007166:Immunosuppressive Agents