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. 2022 Mar;62 Suppl 1(Suppl 1):S58-S62.
doi: 10.1016/j.breast.2021.12.011. Epub 2021 Dec 15.

Locally advanced breast cancer

Stefan Aebi  1 , Per Karlsson  2 , Irene L Wapnir  3
Affiliations

Locally advanced breast cancer

Stefan Aebi et al. Breast. 2022 Mar.

Abstract

Locally advanced breast cancer (LABC) is defined here as inoperable breast adenocarcinoma without distant metastases. Patients with LABC require a multidisciplinary approach. Given the risk of distant metastasis, staging exams are necessary. The incidence of LABC (stages IIIB and IIIC) has decreased in recent years. LABC has rarely been investigated separately: patients with LABC have participated both in clinical trials of palliative and of neoadjuvant therapy. Most trials did not analyze responses and long-term outcomes independently; thus, the treatment of patients with LABC is extrapolated from studies of patients with less or more advanced disease. Pathologic confirmation and molecular profiling are essential for the choice of neoadjuvant chemotherapy. Preoperative endocrine therapy may be considered in certain clinical situations; the addition of a CDK4/6 inhibitor is being investigated. HER2 positive LABCs are targeted with anti-HER2 agents combined with chemotherapy. PD-1 and PD-L1 antibodies in 'triple-negative' LABC are promising. Excellent responses to neoadjuvant therapy enable conservative surgery in many patients; however, inflammatory breast cancer may still indicate mastectomy. Postoperative radiotherapy is usually indicated. Target volumes include breast/chest wall, axillary, supraclavicular and internal mammary nodal basins. Preoperative radiation therapy can be useful in patients without response to systemic therapies. Palliative surgery for poor responders after neoadjuvant systemic and radiation therapy can be considered. Multidisciplinary teams can optimize local control and prevent relapses. However, modest improvement in survival was achieved between 2000 and 2014 underscoring the unmet need in patients with LABC who will benefit from specific research efforts in this disease entity.

Keywords: Locally advanced breast cancer; Multidisciplinary care; Neoadjuvant systemic therapy.

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Conflict of interest statement

The authors report no conflicts of interest related to this article.

Figures

Fig. 1
Fig. 1
Incidence of locally advanced breast cancer [36].
Fig. 2
Fig. 2
Locally advanced breast cancer, general workflow.
Fig. 3
Fig. 3
Five year breast cancer specific survival of patients with Stage IIIB and IIIC breast cancer [36].
See this image and copyright information in PMC

References

    1. Nordenskjold A.E., Fohlin H., Arnesson L.G., Einbeigi Z., Holmberg E., Albertsson P., et al. Breast cancer survival trends in different stages and age groups - a population-based study 1989-2013. Acta Oncol. 2019;58(1):45–51. - PubMed
    1. Ravaioli A., Pasini G., Polselli A., Papi M., Tassinari D., Arcangeli V., et al. Staging of breast cancer: new recommended standard procedure. Breast Cancer Res Treat. 2002;72(1):53–60. - PubMed
    1. Puglisi F., Follador A., Minisini A.M., Cardellino G.G., Russo S., Andreetta C., et al. Baseline staging tests after a new diagnosis of breast cancer: further evidence of their limited indications. Ann Oncol. 2005;16(2):263–266. - PubMed
    1. Ali B., Mubarik F., Zahid N., Sattar A.K. Clinicopathologic features predictive of distant metastasis in patients diagnosed with invasive breast cancer. JCO Glob Oncol. 2020;6:1346–1351. - PMC - PubMed
    1. Groheux D., Giacchetti S., Delord M., Hindie E., Vercellino L., Cuvier C., et al. 18F-FDG PET/CT in staging patients with locally advanced or inflammatory breast cancer: comparison to conventional staging. J Nucl Med. 2013;54(1):5–11. - PubMed

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