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. 2017 Feb;19(2):149-161.
doi: 10.1007/s12094-016-1520-2. Epub 2016 Jun 17.

Defining the optimal sequence for the systemic treatment of metastatic breast cancer

J A Mestres  1 , A B iMolins  2 , L C Martínez  3 , J I C López-Muñiz  4 , E C Gil  5 , A de Juan Ferré  6 , S Del Barco Berrón  7 , Y F Pérez  8 , J G Mata  9 , A G Palomo  10 , J G Gregori  11 , P G Pardo  12 , J J I Mañas  13 , A L Hernández  14 , E M de Dueñas  15 , N M Jáñez  16 , S M Murillo  17 , J S Bofill  18 , P Z Auñón  19 , P Sanchez-Rovira  20
Affiliations

Defining the optimal sequence for the systemic treatment of metastatic breast cancer

J A Mestres et al. Clin Transl Oncol. 2017 Feb.

Abstract

Metastatic breast cancer is a heterogeneous disease that presents in varying forms, and a growing number of therapeutic options makes it difficult to determine the best choice in each particular situation. When selecting a systemic treatment, it is important to consider the medication administered in the previous stages, such as acquired resistance, type of progression, time to relapse, tumor aggressiveness, age, comorbidities, pre- and post-menopausal status, and patient preferences. Moreover, tumor genomic signatures can identify different subtypes, which can be used to create patient profiles and design specific therapies. However, there is no consensus regarding the best treatment sequence for each subgroup of patients. During the SABCC Congress of 2014, specialized breast cancer oncologists from referral hospitals in Europe met to define patient profiles and to determine specific treatment sequences for each one. Conclusions were then debated in a final meeting in which a relative degree of consensus for each treatment sequence was established. Four patient profiles were defined according to established breast cancer phenotypes: pre-menopausal patients with luminal subtype, post-menopausal patients with luminal subtype, patients with triple-negative subtype, and patients with HER2-positive subtype. A treatment sequence was then defined, consisting of hormonal therapy with tamoxifen, aromatase inhibitors, fulvestrant, and mTOR inhibitors for pre- and post-menopausal patien ts; a chemotherapy sequence for the first, second, and further lines for luminal and triple-negative patients; and an optimal sequence for treatment with new antiHER2 therapies. Finally, a document detailing all treatment sequences, that had the agreement of all the oncologists, was drawn up as a guideline and advocacy tool for professionals treating patients with this disease.

Keywords: Chemotherapy; HER2 receptor; Hormone therapy; Metastatic breast cancer; Targeted therapies; Triple-negative tumor.

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Conflict of interest statement

The authors declare no conflict of interest. Research involving human participants and/or animals Not applicable to this type of consensus document. Informed consent Not applicable to this type of consensus document.

Figures

Fig. 1
Fig. 1
General treatment regimens for metastatic breast cancer
Fig. 2
Fig. 2
Proposed hormone therapy for pre-menopausal patients with hormone receptor-positive disease
Fig. 3
Fig. 3
Proposed hormone therapy for hormone receptor-positive patients post-menopause or after ovarian ablation
Fig. 4
Fig. 4
Proposed chemotherapy treatment for patients with hormone receptor-positive disease
Fig. 5
Fig. 5
Proposed treatment for patients with HER2-positive breast cancer
Fig. 6
Fig. 6
Proposed treatment for patients with triple-negative metastatic cancer de novo or with a progression-free survival greater than 12 months
Fig. 7
Fig. 7
Proposed treatment for patients with triple-negative metastatic cancer with a progression-free survival less than 12 months
See this image and copyright information in PMC

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