AGO Recommendations for the Diagnosis and Treatment of Patients with Locally Advanced and Metastatic Breast Cancer: Update 2020

Ditsch, Nina; Untch, Michael; Kolberg-Liedtke, Cornelia; Jackisch, Christian; Krug, David; Friedrich, Michael; Janni, Wolfgang; Müller, Volkmar; Albert, Ute‐Susann; Banys-Paluchowski, Malgorzata; Bauerfeind, Ingo; Blohmer, Jens-Uwe; Budach, Wilfried; Dall, P.; Diel, Ingo J.; Fallenberg, Eva Maria; Fasching, Peter A.; Fehm, Tanja; Gerber, Bernd; Gluz, Oleg; Hanf, Volker; Harbeck, Nadia; Heil, Jörg; Huober, Jens; Kreipe, Hans; Kühn, Thorsten; Kümmel, Sherko; Loibl, Sibylle; Lüftner, Diana; Lux, Michael P.; Maass, Nicolaì; Moebus, Volker; Mundhenke, Christoph; Park‐Simon, Tjoung‐Won; Reimer, Toralf; Rhiem, Kerstin; Rody, Achim; Schmidt, Marcus; Schneeweiß, Andreas; Solbach, C.; Solomayer, Erich‐Franz; Stickeler, Elmar; Thomssen, Christoph; Witzel, Isabell; Wöckel, Achim; Thill, Marc

doi:10.1159/000508736

Cited by 49 publications

(70 citation statements)

References 269 publications

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“…In case of endocrine resistance, the guidelines recommend sequential single-agent CT as the preferred choice for MBC. Combination CT should be reserved for patients with rapid clinical progression, life-threatening visceral metastases, and/or the need for rapid symptom/disease control (Cardoso et al 2020;Ditsch et al 2020;Thomssen et al 2020). Nevertheless, there still remains a high medical need for new therapy options in MBC that prolong the time between endocrine failure and CT, the latter being potentially associated with impaired QoL and more severe side effects.…”

Section: Discussionmentioning

confidence: 99%

“…The goal of care in this situation is to reach a prolonged overall survival (OS) with adequate quality of life (QoL) and thus to establish a disease chronification using treatment options that provide an optimal therapeutic index (Harbeck and Gnant 2017). Single-agent chemotherapy (CT) is recommended as a preferred choice for patients with HR+/HER2−, non-life-threatening MBC after failure of endocrine treatment (Ditsch et al 2020). Among available agents, vinorelbine (VRL) represents a standard treatment option in this situation, as it provides proven efficacy and a good safety profile (Fumoleau et al 1993;Terenziani et al 1996).…”

Section: Introductionmentioning

confidence: 99%

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Phase II study of metronomic treatment with daily oral vinorelbine as first-line chemotherapy in patients with advanced/metastatic HR+/HER2− breast cancer resistant to endocrine therapy: VinoMetro—AGO-B-046

Krajnak¹,

Decker²,

Schollenberger

et al. 2021

J Cancer Res Clin Oncol

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Purpose Metronomic chemotherapy (MCT) is an increasingly used treatment option in hormone receptor-positive (HR+)/human epidermal growth factor receptor 2-negative (HER2−) advanced/metastatic breast cancer (MBC) after failure of endocrine-based therapies. Methods VinoMetro was a multicentre, open-label, single-arm, phase II study of metronomic oral vinorelbine (VRL; 30 mg/day) as a first-line chemotherapy (CT) in patients with HR+/HER2− MBC after endocrine failure. The primary endpoint was the clinical benefit rate (CBR) at 24 weeks. Results Between January 2017 and April 2019, nine patients were enrolled. The CBR was 22.2% (90% confidence interval [CI] 4.1–55.0), p = 0.211. The median progression-free survival (PFS) was 12.0 weeks (95% CI 11.3–12.7). Grade 3–4 adverse events (AEs) occurred in 22.2% of patients. One patient died of febrile neutropenia. Conclusion VinoMetro (AGO-B-046) was closed early after nine patients and occurrence of one grade 5 toxicity in agreement with the lead institutional review board (IRB). Metronomic dosing of oral VRL in HR+/HER2− MBC as first-line CT after failure of endocrine therapies showed only limited benefit in this population. Trial registration number and date of registration ClinicalTrials.gov Identifier: NCT03007992; December 15, 2016.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Phase II study of metronomic treatment with daily oral vinorelbine as first-line chemotherapy in patients with advanced/metastatic HR+/HER2− breast cancer resistant to endocrine therapy: VinoMetro—AGO-B-046

Krajnak¹,

Decker²,

Schollenberger

et al. 2021

J Cancer Res Clin Oncol

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“…Diese Übersichtsarbeit fasst die neuesten Studienergebnisse zur Prävention und Therapie von Patientinnen mit Mammakarzinom in frühen Krankheitsstadien zusammen. Die Entwicklungen der letzten Jahre zeigen, dass Neuerungen in der Behandlung mit hoher Geschwindigkeit in den klinischen Alltag eingeführt werden 1 , 2 , 3 , 4 , 5 , 6 . Berücksichtigt wurden Vollpublikationen und Präsentationen der aktuellen relevanten Krebs- und Brustkrebskongresse wie z.…”

Section: Einführungunclassified

“…This review summarises the latest study outcomes in prevention and treatment of patients with early-stage breast cancer. Developments in recent years have shown that treatment innovations enter clinical practice at a rapid pace 1 , 2 , 3 , 4 , 5 , 6 . This paper includes full publications and presentations at the current major cancer and breast cancer meetings such as ESMO (European Society for Medical Oncology) 2020 and SABCS (San Antonio Breast Cancer Symposium) 2020.…”

Section: Introductionmentioning

confidence: 99%

Update Breast Cancer 2021 Part 1 – Prevention and Early Stages

Stickeler

Aktas

Behrens

et al. 2021

Geburtshilfe Frauenheilkd

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This review summarises not only the latest evidence on prevention, but also the current research on the treatment of early-stage breast cancer patients. Recent years have seen a growing body of evidence on the risk of high- and moderate-penetrance breast cancer susceptibility genes. A large international consortium has now been able to further refine the answer to the question of the significance of the so-called panel genes. Moreover, the data on treatment selection regarding endocrine efficacy and the decision for or against chemotherapy have also been advanced markedly. There is also new data on adjuvant CDK4/6 (cyclin-dependent kinase 4/6) inhibitors, which are standard in first-line treatment in patients with metastatic HER2-negative, hormone receptor-positive (HR+) breast cancer. For other therapies such as immune checkpoint inhibitors, which have successfully improved the rate of pathologic complete response (pCR) in neoadjuvant treatment settings for patients with triple-negative breast cancer (TNBC), there is a growing understanding of the quality of life and side effects. This is especially important in situations where patients could possibly be cured without such a regimen.

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“…It remains unclear whether early detection of asymptomatic BM in breast cancer patients leads to improved clinical outcomes. Currently, BM screening is not part of the management of patients with breast cancer [ 12 , 13 , 14 ], although brain MRI screening is part of the clinical routine for the management of patients with lung cancer [ 15 , 16 ], which also has a high propensity to metastasize in the brain [ 17 , 18 , 19 , 20 ].…”

Section: Introductionmentioning

confidence: 99%

Characteristics and Clinical Outcome of Breast Cancer Patients with Asymptomatic Brain Metastases

Laakmann

Witzel

Neunhöffer³

et al. 2020

Cancers

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Background: Brain metastases (BM) have become a major challenge in patients with metastatic breast cancer. Methods: The aim of this analysis was to characterize patients with asymptomatic BM (n = 580) in the overall cohort of 2589 patients with BM from our Brain Metastases in Breast Cancer Network Germany (BMBC) registry. Results: Compared to symptomatic patients, asymptomatic patients were slightly younger at diagnosis (median age: 55.5 vs. 57.0 years, p = 0.01), had a better performance status at diagnosis (Karnofsky index 80–100%: 68.4% vs. 57%, p < 0.001), a lower number of BM (>1 BM: 56% vs. 70%, p = 0.027), and a slightly smaller diameter of BM (median: 1.5 vs. 2.2 cm, p < 0.001). Asymptomatic patients were more likely to have extracranial metastases (86.7% vs. 81.5%, p = 0.003) but were less likely to have leptomeningeal metastasis (6.3% vs. 10.9%, p < 0.001). Asymptomatic patients underwent less intensive BM therapy but had a longer median overall survival (statistically significant for a cohort of HER2-positive patients) compared to symptomatic patients (10.4 vs. 6.9 months, p < 0.001). Conclusions: These analyses show a trend that asymptomatic patients have less severe metastatic brain disease and despite less intensive local BM therapy still have a better outcome (statistically significant for a cohort of HER2-positive patients) than patients who present with symptomatic BM, although a lead time bias of the earlier diagnosis cannot be ruled out. Our analysis is of clinical relevance in the context of potential trials examining the benefit of early detection and treatment of BM.

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AGO Recommendations for the Diagnosis and Treatment of Patients with Locally Advanced and Metastatic Breast Cancer: Update 2020

Cited by 49 publications

References 269 publications

Phase II study of metronomic treatment with daily oral vinorelbine as first-line chemotherapy in patients with advanced/metastatic HR+/HER2− breast cancer resistant to endocrine therapy: VinoMetro—AGO-B-046

Phase II study of metronomic treatment with daily oral vinorelbine as first-line chemotherapy in patients with advanced/metastatic HR+/HER2− breast cancer resistant to endocrine therapy: VinoMetro—AGO-B-046

Update Breast Cancer 2021 Part 1 – Prevention and Early Stages

Characteristics and Clinical Outcome of Breast Cancer Patients with Asymptomatic Brain Metastases

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