Clinical Review on the Management of Breast Cancer Visceral Crisis

Abstract

Visceral crisis is a life-threatening clinical condition requiring urgent treatment and accounts for 10–15% of new advanced breast cancer diagnoses, mainly hormone receptor-positive/human epidermal growth factor 2 negative. As its clinical definition is an open topic with nebulous criteria and much room for subjective interpretation, it poses a challenge for daily clinical practice. International guidelines recommend combined chemotherapy as first-line treatment for patients with visceral crisis, but with modest results and a very poor prognosis. Visceral crisis has always been a common exclusion criterion in breast cancer trials, and the available evidence mainly comes from limited retrospective studies which are not sufficient to draw solid conclusions. The outstanding efficacy of innovative drugs, such as CDK4/6 inhibitors, questions the role of chemotherapy in this setting. In the lack of clinical reviews, we aim to critically discuss the management of visceral crisis, advocating future treatment perspectives for this challenging condition.

Visceral crisis in metastatic breast cancer: an old concept with new perspectives

“…It is possible that traditional chemotherapy could reduce the quality of life without significantly improving survival. 35 A high prevalence of patients receiving chemotherapy in the last month of life is reported, estimated from 42 % to 65 % in different cohorts. 6 , 8 This is an important consideration since not in all situations the presence of VC will justify the use of active oncologic therapy.…”