Breast cancer experts around the world have issued a plea to researchers, academics, drug companies, funders, and advocates to carry out high quality research and clinical trials for advanced breast cancer, a disease which is almost always fatal and for which there are many unanswered questions.

At present, researchers would initially investigate a treatment in patients with advanced beast cancer but once there were enough data on efficacy and safety, attention shifted quickly to further testing in patients with early disease, leaving little if any research continuing in advanced breast cancer patients.

Advanced breast cancer is defined as cancer that has spread beyond the site of the first (primary) tumor 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). Approximately 20% of cases, almost 60% of cases in developing countries, are either locally advanced or metastatic at diagnosis. A third of all early breast cancer cases will become metastatic even with the best care, and average overall survival for these patients is approximately 2 to 3 years.

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In the latest international consensus guidelines for the management of advanced breast cancer, published simultaneously in the leading cancer journals The Breast (2014; doi:10.1016/j.breast.2014.08.009) and Annals of Oncology (2014; doi:10.1093/annonc/mdu385), experts say that further research and clinical trials are urgently needed to find best treatments, including for metastasized breast cancer, HER2-positive advanced breast cancer with relapse after or during trastuzumab treatment, stage IV breast cancer, and advanced breast cancer in men.

In addition, there are a number of other areas in advanced breast cancer that require more and better research and international, multidisciplinary clinical trials. Greater efforts are needed to educate health professionals to apply existing knowledge in their treatment of breast cancer patients.

“Our plea is for strong commitment from everyone involved—academia, the pharmaceutical industry, funders, and advocacy groups—to develop well-designed, high quality, multidisciplinary trials for advanced breast cancer. This is of critical importance as many questions are still unanswered relating to management strategies, better drugs and drug use, and individualizing treatments so they are specific to a particular patient and their tumor,” said Fatima Cardoso, MD, lead author and co-chair of these latest international guidelines and Director of the Breast Unit of the Champalimaud Cancer Centre in Lisbon, Portugal.

“So this is what we plead for: that yes, once you have enough data, move to the early setting, but remain and keep investing some effort in understanding how best to treat the advanced breast cancer patient. They are one third of all breast cancer patients and they deserve that,” said Cardoso.