title: A definition for aggressive disease in patients with HER-2 negative metastatic breast cancer: an expert consensus of the Spanish Society of Medical Oncology (SEOM).
abstract: OBJECTIVE
  To converge on an expert opinion to define aggressive disease in patients with HER2-negative mBC using a modified Delphi methodology.
  
  
  METHODS
  A panel of 21 breast cancer experts from the Spanish Society of Medical Oncology agreed upon a survey which comprised 47 questions that were grouped into three sections: relevance for defining aggressive disease, aggressive disease criteria and therapeutic goals. Answers were rated using a 9-point Likert scale of relevance or agreement.
  
  
  RESULTS
  Among the 88 oncologists that were invited to participate, 81 answered the first round (92%), 70 answered the second round (80%), and 67 answered the third round (76%) of the survey. There was strong agreement regarding the fact that identifying patients with aggressive disease needs to be adequately addressed to help practitioners to decide the best treatment options for patients with HER2-negative mBC. The factors that were considered to be strongly relevant to classifying patients with aggressive HER2-negative mBC were a high tumor burden, a disease-free interval of less than 12-24 months after surgery, the presence of progressive disease during adjuvant or neoadjuvant chemotherapy and having a triple-negative phenotype. The main therapeutic goals were controlling symptoms, improving quality of life and increasing the time to progression and overall survival.
  
  
  CONCLUSIONS
  High tumor burden, time to recurrence after prior therapy and having a triple-negative phenotype were the prognostic factors for which the greatest consensus was found for identifying patients with aggressive HER2-negative mBC. Identifying patients with aggressive disease leads to different therapeutic approaches.
authors.affiliation: Medical Oncology Department, MD Anderson Cancer Center, C/Arturo Soria, 270, 28033, Madrid, Spain. agonzalezm@seom.org.
authors.forename: A
authors.initials: A
authors.lastname: González
authors.affiliation: Hematology and Oncology Department, Hospital Clínico Universitario de Valencia, Valencia, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Lluch
authors.affiliation: Medical Oncology Department, Hospital Universitario Virgen de la Victoria, Málaga, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Aba
authors.affiliation: Medical Oncology Department, Hospital Parc de Salut Mar, Barcelona, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Albanell
authors.affiliation: Medical Oncology Department, Hospital Miguel Servet, Zaragoza, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Antón
authors.affiliation: Medical Oncology Department, Hospital Universitario Donostia, San Sebastián, Spain.
authors.forename: I
authors.initials: I
authors.lastname: Álvarez
authors.affiliation: Medical Oncology Department, Hospital Universitario Morales Meseguer, Murcia, Spain.
authors.forename: F
authors.initials: F
authors.lastname: Ayala
authors.affiliation: Medical Oncology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Barnadas
authors.affiliation: Medical Oncology Department, Complejo Hospitalario Universitario de La Coruña, La Coruña, Spain.
authors.forename: L
authors.initials: L
authors.lastname: Calvo
authors.affiliation: Medical Oncology Department, Hospital Universitario 12 de Octubre, Madrid, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Ciruelos
authors.affiliation: Medical Oncology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Cortés
authors.affiliation: Medical Oncology Department, Hospital Universitario Reina Sofía, Córdoba, Spain.
authors.forename: J
authors.initials: J
authors.lastname: de la Haba
authors.affiliation: Medical Oncology Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
authors.forename: J M
authors.initials: JM
authors.lastname: López-Vega
authors.affiliation: Medical Oncology Department, Fundación Hospital Provincial de Castellón, Castellón, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Martínez
authors.affiliation: Medical Oncology Department, Hospital Clínic de Barcelona, Barcelona, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Muñoz
authors.affiliation: Medical Oncology Department, Hospital de Cabueñes, Gijón, Spain.
authors.forename: I
authors.initials: I
authors.lastname: Peláez
authors.affiliation: Medical Oncology Department, Hospital Universitario La Paz, Madrid, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Redondo
authors.affiliation: Medical Oncology Department, Hospital General Universitario de Elche, Elche, Spain.
authors.forename: Á
authors.initials: Á
authors.lastname: Rodríguez
authors.affiliation: Medical Oncology Department, Hospital Universitario de Salamanca-IBSAL, Salamanca, Spain.
authors.forename: C A
authors.initials: CA
authors.lastname: Rodríguez
authors.affiliation: Instituto Valenciano de Oncología, Valencia, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Ruíz
authors.affiliation: Medical Oncology Department, Hospital Universitario Arnau Vilanova, Lleida, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Llombart
mesh_terms: D001943:Breast Neoplasms / Q000145:classification* / Q000473:pathology*; D032921:Consensus; D003697:Delphi Technique; D005260:Female; D006801:Humans; D008495:Medical Oncology / Q000592:standards*; D018719:Erb-b2 Receptor Tyrosine Kinases; D012955:Societies, Medical
chemical_list: D018719:Erb-b2 Receptor Tyrosine Kinases; C508053:ERBB2 protein, human
keywords: Aggressive disease; Consensus; HER2-negative; Metastatic breast cancer