SEOM clinical guidelines in metastatic breast cancer 2015

Gavilá, Joaquín; López-Tarruella, Sara; Saura, Cristina; Muñoz, Montserrat; Oliveira, Mafalda; Cruz‐Merino, Luis de la; Morales, Serafín; Álvarez-López, Isabel; Virizuela, José Antonio; Martín, Miguel

doi:10.1007/s12094-015-1476-7

Cited by 27 publications

(29 citation statements)

References 51 publications

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“…Magnetic resonance imaging (MRI) of the breast and fluorine-18 fluorodeoxyglucose (18F-FDG) positron emission tomography/ computed tomography (PET/CT) are not routinely recommended for initial staging. [3][4][5][6][7][8] Apart from imaging, in patients with clinically positive axilla, pre-treatment disease staging includes histopathological examination of the primary tumor and cytology/ histology of the axillary lymph node (ALN) specimens obtained using ultrasound-guided fine-needle aspiration biopsy or core biopsy to determine whether ALN dissection is needed. In patients with clinically negative axilla, the current standard of ALN staging in early-stage BC is sentinel lymph node biopsy.…”

Section: Introductionmentioning

confidence: 99%

“…In patients with clinically negative axilla, the current standard of ALN staging in early-stage BC is sentinel lymph node biopsy. 5,6 According to BC guidelines such as National Comprehensive Cancer Network (NCCN), European Society for Medical Oncology (ESMO), Spanish Society of Medical Oncology (SEOM), and the National Institute for Care Excellence (NICE), 18F-FDG PET/CT is not indicated in women with apparently early-stage (I or II) BC or even in those with operable stage III BC; [3][4][5][6][7][8] it is considered optional for women with suspicious or equivocal findings on CT or MRI and for women with locally advanced BC, especially those with advanced axillary nodal disease, because the risk of early distant metastases is high enough to justify systemic staging as part of the initial evaluation. In this setting, 18F-FDG PET/CT can detect metastases that are not visible on other modalities, and these findings can change treatment options.…”

Section: Introductionmentioning

confidence: 99%

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18F-FDG PET/CT in breast cancer: Evidence-based recommendations in initial staging

et al. 2017

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Current guidelines do not systematically recommend 18F-FDG PET/CT for breast cancer staging; and the recommendations and level of evidence supporting its use in different groups of patients vary among guidelines. This review summarizes the evidence about the role of 18F-FDG PET/CT in breast cancer staging and the therapeutic and prognostic impact accumulated in the last decade. Other related aspects, such as the association of metabolic information with biology and prognosis are considered and evidence-based recommendations for the use of 18F-FDG PET/CT in breast cancer staging are offered. We systematically searched MEDLINE for articles reporting studies with at least 30 patients related to clinical questions following the Problem/Population, Intervention, Comparison, and Outcome framework. We critically reviewed the selected articles and elaborated evidence tables structuring the summarized information into methodology, results, and limitations. The level of evidence and the grades of recommendation for the use of 18F-FDG PET/CT in different contexts are summarized. Level III evidence supports the use of 18F-FDG PET/CT for initial staging in patients with recently diagnosed breast cancer; the diagnostic and therapeutic impact of the 18F-FDG PET/CT findings is sufficient for a weak recommendation in this population. In patients with locally advanced breast cancer, level II evidence supports the use of 18F-FDG PET/CT for initial staging; the diagnostic and therapeutic impact of the 18F-FDG PET/CT findings is sufficient for a strong recommendation in this population. In patients with recently diagnosed breast cancer, the metabolic information from baseline 18F-FDG PET/CT is associated with tumor biology and has prognostic implications, supported by level II evidence. In conclusion, 18F-FDG PET/CT is not recommended for staging all patients with early breast cancer, although evidence of improved regional and systemic staging supports its use in locally advanced breast cancer. Baseline tumor glycolytic activity is associated with tumor biology and prognosis.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

18F-FDG PET/CT in breast cancer: Evidence-based recommendations in initial staging

et al. 2017

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“…However, there is some ambivalence about best treatment options for each line. For example, a patient with a HER2-negative, hormone receptor-positive tumor could be treated in the first line with several hormone treatments and with different chemotherapy drugs, such as taxanes, anthracyclines, vinorelbine, or capecitabine in combination with bevacizumab [5, 7, 8]. This wide spectrum, ideal for individualized treatment, can be counterproductive in terms of the uncertainty it generates.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2016

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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 patients; 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.

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“…Despite the advances in prevention, diagnosis and treatment, the clinical management of MBC still presents many challenges and prognosis continues to be poor: MBC is the most frequent cause of cancer death for women worldwide [91,92], with current median survival time of only 18-24 months [93]. This is partly due to the fact that resistance to therapy occurs invariably in MBC, rendering it virtually incurable [94,95]. Current efforts are centred in improving survival and quality of life [96].…”

Section: Challenges In the Management Of Metastatic Breast Cancermentioning

confidence: 99%

“…Evidence suggests that treatment with endocrine therapy in the adjuvant setting does not significantly influence the rate of response of subsequent recurrent cancers [100]. Endocrine therapy is now the recommended first option for treatment of ER+ MBC, except in cases with visceral involvement, which warrant the administration of chemotherapy instead [94,101,102].…”

Section: Biological Challenges: Temporal Heterogeneity and Resistancementioning

confidence: 99%

The evolving role of receptors as predictive biomarkers for metastatic breast cancer

Martínez-Pérez

Turnbull

Dixon

2018

Expert Review of Anticancer Therapy

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Introduction:In breast cancer, oestrogen receptor (ER) and human epidermal growth factor receptor 2 (HER2) are essential biomarkers to predict response to endocrine and anti-HER2 therapies, respectively. In metastatic breast cancer, the use of these receptors and targeted therapies present additional challenges: temporal heterogeneity, together with limited sampling methodologies, hinders receptor status assessment and the constant evolution of the disease invariably leads to resistance to treatment. Areas covered:We summarise genomic abnormalities in ER and HER2, such as mutations, amplifications, translocations and alternative splicing, emerging as novel biomarkers that provide an insight into underlying mechanisms of resistance and hold potential predictive value to inform treatment selection. We also describe how liquid biopsies for sampling of circulating markers and ultrasensitive detection technologies have emerged which complement ongoing efforts for biomarker discovery and analysis. Expert commentary:While evidence suggests that genomic aberrations in ER and HER2 could contribute to meeting the pressing need for better predictive biomarkers, efforts need to be made to standardise assessment methods and better understand the resistance mechanisms these markers denote. Taking advantage of emerging technologies, research in upcoming years should include prospective trials incorporating these predictors into the study design to validate their potential clinical value.

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SEOM clinical guidelines in metastatic breast cancer 2015

Cited by 27 publications

References 51 publications

18F-FDG PET/CT in breast cancer: Evidence-based recommendations in initial staging

18F-FDG PET/CT in breast cancer: Evidence-based recommendations in initial staging

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

The evolving role of receptors as predictive biomarkers for metastatic breast cancer

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