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 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.
Hospital del Mar, Barcelona, Spain.
J A
JA
Mestres
Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
A B
AB
iMolins
Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain.
L C
LC
Martínez
Hospital Virgen de la Salud, Toledo, Spain.
J I C
JI
López-Muñiz
Hospital Universitario 12 de Octubre, Madrid, Spain.
E C
EC
Gil
Hospital Universitario Marqués de Valdecilla, Santander, Spain.
A
A
de Juan Ferré
Institut Català d'Oncologia, Girona, Spain.
S
S
Del Barco Berrón
Hospital Universitario Central de Asturias, Oviedo, Spain.
Y F
YF
Pérez
Hospital Santa María Nai en Ourense, Orense, Spain.
J G
JG
Mata
Complejo Asistencial de León, Léon, Spain.
A G
AG
Palomo
Fundación Instituto Valenciano de Oncología, Valencia, Spain.
J G
JG
Gregori
Hospital Universitari Vall d'Hebron, Barcelona, Spain.
P G
PG
Pardo
Complejo Hospitalario de Navarra, Pamplona, Spain.
J J I
JJ
Mañas
Hospital Clínic Universitari de València, València, Spain.
A L
AL
Hernández
Consorcio Hospitalario i Provincial de Castellón, Castellón, Spain.
E M
EM
de Dueñas
Hospital Universitario Ramón y Cajal, Madrid, Spain.
N M
NM
Jáñez
Hospital Universitari Arnau de Vilanova, Lleida, Spain.
S M
SM
Murillo
Hospital Universitario Nuestra Señora de Valme, Seville, Spain.
J S
JS
Bofill
Hospital Universitario La Paz, Madrid, Spain.
P Z
PZ
Auñón
Complejo Hospitalario de Jaén, Jaén, Spain. oncopsr@yahoo.es.
P
P
Sanchez-Rovira
D000970:Antineoplastic Agents / Q000592:standards* / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000378:metabolism / Q000473:pathology; D005260:Female; D006801:Humans; D011379:Prognosis; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000378:metabolism; D011960:Receptors, Estrogen / Q000378:metabolism; D011980:Receptors, Progesterone / Q000378:metabolism
D000970:Antineoplastic Agents; D018719:Erb-b2 Receptor Tyrosine Kinases; D011960:Receptors, Estrogen; D011980:Receptors, Progesterone
Chemotherapy; HER2 receptor; Hormone therapy; Metastatic breast cancer; Targeted therapies; Triple-negative tumor