Lisbon, Portugal: International experts have called for a clinical trial to investigate the best ways for identifying and treating a small but important group of patients with advanced breast cancer who can survive for long periods without their disease progressing.
Although advanced breast cancer  is incurable, there are some patients who have just a few small metastases (clusters of cancer cells that have travelled to other parts of the body) and who would respond well to systemic treatments such as chemo- and hormone therapy. In new guidelines agreed by participants at the Advanced Breast Cancer Third International Consensus Conference, the experts said these patients could achieve complete remission from their disease and long survival if given the most appropriate treatments.
Co-chair of the conference, Professor Fatima Cardoso, said: “A prospective clinical trial addressing this specific situation is needed. These patients would be likely to benefit from a variety of different approaches to treatment, aimed at both the primary tumour as well as the metastases. But the best ways of selecting these patients and choosing the right treatments for them need to be investigated in a trial.”
In the new consensus guidelines, the experts point out that, as survival is improving in many patients with advanced breast cancer, consideration of a number of issues that arise for these people should be part of their routine care, such as:
* changing and adapting treatment strategies depending on the status of the disease;
* systematic monitoring for, and alleviating, the side effects of treatment and working to improve patients’ quality of life;
* adjusting treatments to suit patients’ priorities and plans for their lives;
* incorporating measures into treatment planning that take account of the needs of the patients and their families, their jobs and social requirements.
In a world in which the means of communications are changing all the time, the new consensus guidelines highlight the importance of harnessing technology to improve cancer treatment, particularly for patients living in remote areas and in developing countries.
“Telemedicine oncology is an important option to consider when geographic distances are a problem, provided that connectivity problems can be overcome,” said Professor Cardoso, who is Director of the Breast Unit of the Champalimaud Cancer Centre in Lisbon, Portugal.
As the cost of new, cutting-edge drugs and other treatments for advanced breast cancer continues to rise, the experts also highlighted the problem of their affordability, and stressed the need to use objective measures to evaluate the effectiveness of therapies.
“We strongly recommend the use of objective methods to evaluate the real magnitude of benefit provided by a new treatment in order to help prioritise funding, particularly in countries with limited resources,” said Dr Eric Winer, director of breast oncology at the Dana-Farber Cancer Institute (Boston, USA) and co-chair of the conference. “However, doctors should be guided at all times by patient well-being, length of life and preferences, and should reach balanced decisions in all cases.”
The consensus guidelines make a number of new or modified recommendations on the treatment and management of all types of advanced breast cancer. The conference was attended by a large number of patients who were involved in the discussions and decision-making processes. For them, the management of cancer or treatment-related problems are important and are addressed in the guidelines. These problems include:
* cancer-related fatigue, which can have a severe impact on quality of life
* neutropaenia (low levels of white blood cells in the blood)
* non-infectious pneumonitis (inflammation of the air sacs in the lungs)
* mucositis and stomatitis (inflammations of mucous membranes in the digestive tract and mouth)
* dyspnoea (breathlessness)
* nausea and vomiting
“CJ” (Dian) Corneliussen-James, co-founder and President of METAvivor (a US organisation that funds research to transition metastatic breast cancer into a survivable condition), who has been living with advanced breast cancer for nine years, said: “These guidelines are critical, especially for patients living in parts of the world where there are no specialist oncology centres. These allow the doctors in these regions to know what some of the world’s leading oncologists are recommending, thereby optimising the care of their patients.”
The International Consensus Guidelines Conferences on Advanced Breast Cancer (ABC), held in Lisbon (Portugal) every two years, were created by the European School of Oncology (ESO) and jointly developed with European Society for Medical Oncology (ESMO) in order to improve outcomes for patients with advanced breast cancer. Nearly 1200 participants from 84 countries attended this third ABC.
 Advanced breast cancer is defined as cancer that has spread beyond the site of the first (primary) tumour to other sites either within the same breast such as the skin, chest wall and some lymph nodes (locally advanced) or other parts of the body (metastatic cancer). There are no reliable figures for the numbers of women (and men) living with advanced breast cancer. However, there are over 1.6 million new cases of breast cancer a year in the world and 0.5 million deaths. About 20% of cases are either locally advanced or have spread to other parts of the body (metastasised) at diagnosis, and these figures reach almost 60% in developing countries. A third of all early breast cancer cases will become metastatic even with the best care, and the average overall survival for these patients is around two to three years.