International Experts Call for Investigations Into Long-Term Management Options for Select Patients With Advanced Breast Cancer

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. This announcement was made at the Advanced Breast Cancer Third International Consensus Conference.

Although advanced breast cancer is incurable, some patients have just a few small metastases and would respond well to systemic treatments such as chemotherapy and hormone therapy. In new guidelines agreed by conference participants, the experts said these patients could achieve complete remission from their disease and long survival if given the most appropriate treatments.

"A prospective clinical trial addressing this specific situation is needed,” said co-chair of the conference, Professor Fatima Cardoso, MD. “These patients would be likely to benefit from a variety of different approaches to treatment, aimed at both the primary tumor 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; and incorporating measures into treatment planning that take into account 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 Cardoso.

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 prioritize funding, particularly in countries with limited resources," said Eric Winer, MD, director of breast oncology at the Dana-Farber Cancer Institute in Boston, Massachusetts, 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 is important and is addressed in the guidelines.

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