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Review
. 2022 Apr;7(2):100409.
doi: 10.1016/j.esmoop.2022.100409. Epub 2022 Feb 26.

Major advancements in metastatic breast cancer treatment: when expanding options means prolonging survival

F Miglietta  1 , M Bottosso  1 , G Griguolo  2 , M V Dieci  2 , V Guarneri  3
Affiliations
Review

Major advancements in metastatic breast cancer treatment: when expanding options means prolonging survival

F Miglietta et al. ESMO Open. 2022 Apr.

Erratum in

Abstract

In the last years we have witnessed tremendous advancements in the treatment landscape of metastatic breast cancer (MBC), leading to a progressive prolongation of progression-free survival and, in some cases, also of overall survival. This led to a substantial increase of advanced disease treatability. In the present review we comprehensively and critically describe the most significant progresses in the therapeutic scenario of MBC according to BC subtype. In particular, we reviewed studies reporting practice-changing data in hormone receptor-positive/human epidermal growth factor receptor 2 (HER2)-negative, HER2-positive and triple-negative BC, with also a hint to BRCA-related tumors and the emerging HER2-low-positive category.

Keywords: chemotherapy; endocrine therapy; metastatic breast cancer; patient selection; targeted therapy.

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Conflict of interest statement

Disclosure GG reports personal fees from Eli Lilly and Novartis, outside the submitted work. MVD reports personal fees from Eli Lilly, Exact Sciences, Novartis, Pfizer, Seagen, outside the submitted work. VG reports personal fees from Novartis, Roche, Eli Lilly, MSD, outside the submitted work. The remaining authors declare no competing interests.

Figures

Figure 1
Figure 1
Timeline of main breakthrough therapies across breast cancer (BC) subtypes. HR, hormone receptor; PALBO, palbociclib; FULV, fulvestrant; AI, aromatase inhibitor; RIBO, ribociclib; ABEMA, abemaciclib; mut, mutated; gBRCA, BRCA germline mutation; neg, negative; PDL1, Programmed death-ligand 1; ATEZO, atezolizumab; NAB-P, nab-paclitaxel; PEMBRO, pembrolizumab, CT, chemotherapy; H, trastuzumab; P, docetaxel; T-DM1, trastuzumab emtansine; T-DXd, trastuzumab deruxtecan; CAPE, capecitabine; MARGETUX, margetuximab; FDA, Food and Drug Administration; EMA, European Medicines Agency; OS, overall survival. ∗phase I trials.
Figure 2
Figure 2
Main trials investigating first-line strategies across breast cancer (BC) subtypes with progression-free survival (PFS) and overall survival (OS) results. Trials investigating CDK 4/6 inhibitors in endocrine-resistant HR+/HER2– metastatic breast cancer (MBC) have been included because they also covered the first-line setting in case of early relapse from endocrine therapy for early-stage disease. HR, hormone receptor; HER2, human epidermal growth factor receptor 2; MBC, metastatic breast cancer; DFI, disease-free interval; ET, endocrine therapy; EBC, early breast cancer; R, randomization; PD, progressive disease; NSAI, non-steroidal aromatase inhibitor; OFS, ovarian function suppression; Tam, tamoxifene; PFS, progression-free survival; OS, overall survival; CT, chemotherapy; NR, not reached.
Figure 3
Figure 3
Progression-free survival (PFS) and overall survival (OS) results from major randomized clinical trials testing anti-HER2 strategies according to treatment line., , ,,, , ,, , , , HER2, human epidermal growth factor receptor 2; CT, chemotherapy; H, trastuzumab; P, pertuzumab; Tax, taxane; Cape, capecitabine; LAP, lapatinib; T-DM1, trastuzumab emtansine; T-DXd, trastuzumab deruxtecan; TPC, treatment of physician choice; TUC, tucatinib; NER, neratinib; MARG, margetuximab; NR, not reached; m, months.
Figure 4
Figure 4
Currently active phase II and III trials for metastatic breast cancer (MBC) divided according to BC subtypes and drug categories (source:ClinicalTrials.gov; at 25 November 2021). inh, inhibitor; mTOR, mammalian target of rapamycin; SERDs, selective estrogen receptor degraders, IMMUNO; immunotherapy; ADC, antibody drug conjugate; mAB, monoclonal antibody; TKI, tyrosine kinase inhibitor; PARP, poly-ADP-ribose polymerase; HR, hormone receptor.
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