International Guidelines for Management of Metastatic Breast Cancer: Can Metastatic Breast Cancer Be Cured?

Abstract

A distinctive subset of metastatic breast cancer (MBC) is oligometastatic disease, which is characterized by single or few detectable metastatic lesions. The existing treatment guidelines for patients with localized MBC include surgery, radiotherapy, and regional chemotherapy. The European School of Oncology–Metastatic Breast Cancer Task Force addressed the management of these patients in its first consensus recommendations published in 2007. The Task Force endorsed the possibility of a more aggressive and multidisciplinary approach for patients with oligometastatic disease, stressing also the need for clinical trials in this patient population. At the sixth European Breast Cancer Conference, held in Berlin in March 2008, the second public session on MBC guidelines addressed the controversial issue of whether MBC can be cured. In this commentary, we summarize the discussion and related recommendations regarding the available therapeutic options that are possibly associated with cure in these patients. In particular, data on local (surgery and radiotherapy) and chemotherapy options are discussed. Large retrospective series show an association between surgical removal of the primary tumor or of lung metastases and improved long-term outcome in patients with oligometastatic disease. In the absence of data from prospective randomized studies, removal of the primary tumor or isolated metastatic lesions may be an attractive therapeutic strategy in this subset of patients, offering rapid disease control and potential for survival benefit. Some improvement in outcome may also be achieved with optimization of systemic therapies, possibly in combination with optimal local treatment.

LB100, a small molecule inhibitor of PP2A with potent chemo- and radio-sensitizing potential

“…92 Despite significant progress in screening and early detection, many patients experience local or regional recurrence, metastasis, and resistance to conventional chemotherapies. 93,94 Numerous studies have elucidated some of the many mechanisms of drug resistance in breast cancer. 95 TNF-related apoptosis-inducing ligand (TRAIL), a member of the tumor necrosis family, is an integral initiator of the extrinsic apoptosis pathway.…”

Potential antiproliferative effect of isoxazolo- and thiazolo coumarin derivatives on breast cancer mediated bone and lung metastases

“…A subset of normal or hyperplastic breast duct clusters showing malignancy-associated changes, including focal disruptions in the surrounding myoepithelial cell layer and basement membrane, expression of p53 and HER-2, and morphological signs of stromal and vascular invasion, can progress directly into invasive or metastatic lesions to other organs in the body, the favourite sites being the bones, lungs, liver or brain (12,13). Although an incurable condition, metastatic breast cancer treatment, chemotherapy drugs, antiestrogen and biologic therapy, can prolong life, delay the progression of cancer, relieve cancer-related symptoms and improve the quality of life (14)(15)(16)(17). Despite an ever-expanding armamentarium of cytotoxics, endocrine therapies, biologics and small-molecule inhibitors, metastatic breast cancer is still the leading cause of death in women aged 40 to 55, which emphasizes the need for new drugs and combination therapies that will selectively act on specifi c tumour targets and improve the overall survival with low toxicity.…”

Sustainability of Eribulin Treatment for Patients with Metastatic Breast Cancer: is the Cost of the Drug Related to the Benefit Produced (Effectiveness and Safety)? a Single Center Experience

“…Despite the multiple options available, there is no consensus as to which drug is to be preferred in pretreated MBC (9,13,14). Innovative and expensive drugs often appear to be the main cost drivers in cancer treatment, particularly for MBC.…”