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ESMO Press Commentary: First international consensus guidelines published on locally advanced and metastatic breast cancer

Publication of the first international consensus guidelines on locally advanced and metastatic breast cancer
23 Sep 2014
Breast cancer

Lugano, Switzerland, 23 September 2014 – The first international consensus guidelines on locally advanced and metastatic breast cancer have been published in Annals of Oncology and The Breast. (1) They are a collaborative effort between ESMO and the European School of Oncology (ESO).

Previous consensus guidelines on advanced breast cancer were published in 2011 and focused on metastatic breast cancer.(2) The 2014 document also now provides recommendations on local and regional advanced breast cancer without metastases for the first time.

Prof Nadia Harbeck, co-author of the paper and also of the previous ESMO Clinical Practice Guidelines on Locally Recurrent and Metastatic Breast Cancer and head of the Breast Centre, University of Munich, Germany, said: “Local and regional advanced breast cancer without metastases is an intermediate clinical diagnosis between early stage breast cancer and metastasised breast cancer. There is little data in this area and a lot of individualised therapy concepts. In the paper we summarise the evidence and provide recommendations to give these patients the best possible medical care.”

Also new are the definitions for endocrine resistance, a term used for patients who do not respond well to endocrine therapy, and visceral crisis, a situation in which patients have advanced life threatening liver disease and chemotherapy is therefore indicated. Harbeck said: “Standard international terminology is needed so that findings from clinical trials on new therapies can be applied to clearly defined clinically relevant patient populations. Until now different terms have been used making it difficult to apply drug approvals given for one study population to patients in clinical practice.”

Novel recommendations are provided for specific metastatic sites including pleural effusions, liver metastases and chest wall recurrences. And there are updates which incorporate new evidence on everolimus in hormone receptor positive disease, and the new anti-HER2 drugs pertuzumab and trastuzumab emtansine (TDM1).

Commenting on the impact the ESO-ESMO guidelines will have, Harbeck said: “This document will help oncologists around the world improve their practice and the care they provide to patients with advanced breast cancer because the recommendations were agreed upon by an international group of clinicians from different specialties like radiotherapy, radiology, pathology, gynaecology and medical oncology as well as patient advocates.”

She added: “The consensus group also reflects different reimbursement situations in countries with more or less resources. We found a common ground looking at the evidence but also taking into account that not every country has access to certain medications and treatment strategies.”

“The document is like a corridor that clinicians can walk and treat their patients in, it’s not a cookbook which says exactly what to do for each individual patient,” continued Harbeck. “I’m convinced that this will make it acceptable around the world. Clinicians need a corridor so they don’t undertreat patients but the specific medications and strategies depend very much on patient characteristics and preferences as well as availability in certain areas.”

Harbeck concluded: “Advanced breast cancer is a neglected patient population when it comes to research and evidence on which to base practice is scarce. Fortunately the population is getting smaller because our treatments in the early breast cancer setting are so effective. But these patients still have the right to get the same quality of care as patients in the early breast cancer setting and I think with these guidelines we’re now a step closer to achieving that goal.”



1 “ESO-ESMO 2nd international consensus guidelines for advance breast cancer (ABC2)”, by F. Cardoso et al.
Annals of Oncology.2014;25:1871–1888. doi:10.1093/annonc/mdu385
The Breast, doi: 10.1016/j.breast.2014.08.009

2 Cardoso F, Costa A, Norton L et al. 1st International consensus guidelines for advanced breast cancer (ABC1). The Breast. 2012;21(3):242–252.

Last update: 23 Sep 2014

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