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Metastatic Breast Cancer: New ESMO Guideline With Evidence-Based Recommendations [ESMO Press Release]

19 Oct 2021
Cancer Diagnostics;  Staging and Imaging;  Therapy
Breast Cancer

LUGANO, Switzerland – The much-anticipated ESMO Clinical Practice Guideline for the diagnosis, staging and treatment of patients with metastatic breast cancer (1) has been published today in Annals of Oncology. Amidst public information and support initiatives taking place worldwide on the occasion of Breast Cancer Awareness Month, the publication marks a milestone for the translation of recent research achievements into practical improvements to patient care in the era of precision medicine.

With clinical trial evidence on novel therapeutic approaches now sufficiently robust to inform oncologists’ routine decision-making processes, the newly released guideline encompasses all major developments of the last few years to offer a comprehensive picture of the state of the art in advanced breast cancer management. Developed by a panel of 28 of the most prominent experts in this field, it thereby takes the place of the previous reference document, the 5th ESO-ESMO international consensus guidelines for advanced breast cancer. (2)

Prof. Giuseppe Curigliano, Chair of the ESMO Guidelines Committee, stated: “The rapid pace at which scientific knowledge is currently advancing means that new evidence may emerge between the time at which documents like the ESMO Clinical Practice Guidelines are developed and their eventual publication and use by clinicians. The up-to-date guideline on metastatic breast cancer was therefore designed to integrate even the most recent, potentially practice-changing data by providing graded recommendations for different treatment choices according to the levels of evidence available to support them, based on their rating within the ESMO Magnitude of Clinical Benefit Scale (ESMO-MCBS) and the ESMO Scale for the Clinical Actionability of Molecular Targets (ESCAT).”

In a context where the tumour biology of progressive disease is thought to have been altered under the selective pressure of improved treatments for early breast cancer and where emerging targeted therapies could lead to revisions of the current breast cancer subtypes in the future, the ESMO guideline comes on time to support upcoming discussions on possible evolutions in practice—but it will also evolve alongside them.

Going forward, a “living” version of the guidelines to be published on the ESMO website will offer a user-oriented, interactive tool allowing doctors to access treatment algorithms, important reference materials and regular updates as needed, in real time. The corresponding Pan-Asian Guideline Adaptation for metastatic breast cancer, taking into account ethnic, scientific, socioeconomic and regional practice characteristics, will be published in 2022 and provide practitioners working across Asia with an applicable method to optimise patient care in their local context.


  1. A. Gennari, F. André, C. H. Barrios, J. Cortés, E. de Azambuja, A. DeMichele, R. Dent, D. Fenlon, J. Gligorov, S. A. Hurvitz, S.-A. Im, D. Krug, W. G. Kunz, S. Loi, F. Penault Lorca, J. Ricke, M. Robson, H. S. Rugo, C. Saura, P. Schmid, C. F. Singer, T. Spanic, S. M. Tolaney, N. C. Turner, G. Curigliano, S. Loibl, S. Paluch-Shimon and N. Harbeck, on behalf of the ESMO Guidelines Committee. ESMO Clinical Practice Guideline for the diagnosis, staging and treatment of patients with metastatic breast cancer. https://doi.org/10.1016/j.annonc.2021.09.019
  2. F. Cardoso, S. Paluch-Simon, E. Senkus, G. Curigliano, M.S. Aapro, F. André, C.H. Barrios, J. Bergh, G.S. Bhattacharyya, L. Biganzoli, F. Boyle, M.-J. Cardoso, L.A. Carey, J. Cortés, N.S. El Saghir, M. Elzayat, A. Eniu, L. Fallowfield, P.A. Francis, K. Gelmon, J. Gligorov, R. Haidinger, N. Harbeck, X. Hu, B. Kaufman, R. Kaur, B.E. Kiely, S.-B. Kim, N.U. Lin, S.A. Mertz, S. Neciosup, B.V. Offersen, S. Ohno, O. Pagani, A. Prat, F. Penault Lorca, H.S. Rugo, G.W. Sledge, C. Thomssen, D.A. Vorobiof, T. Wiseman, B. Xu, L. Norton, A. Costa and E.P. Winer. 5th ESO-ESMO international consensus guidelines for advanced breast cancer (ABC 5). https://doi.org/10.1016/j.annonc.2020.09.010

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