Defining the optimal sequence for the systemic treatment of metastatic breast cancer
Por:
Mestres, JA, IMolins, AB, Martinez, LC, Lopez-Muniz, JIC, Gil, EC, Ferre, AD, Berron, SD, Perez, YF, Mata, JG, Palomo, AG, Gregori, JG, Pardo, PG, Manas, JJI, Hernandez, AL, de Duenas, EM, Janez, NM, Murillo, SM, Bofill, JS, Aunon, PZ, Sanchez-Rovira, P
Publicada:
1 feb 2017
Resumen:
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 patien ts; 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.
Filiaciones:
Mestres, JA:
Hosp Mar, Barcelona, Spain
IMolins, AB:
Hosp Santa Creu & Sant Pau, Barcelona, Spain
Martinez, LC:
Complejo Hosp Univ A Coruna, A Corua, Spain
Lopez-Muniz, JIC:
Hosp Virgen de la Salud, Toledo, OH, Spain
Gil, EC:
Hosp Univ 12 Octubre, Madrid, Spain
Ferre, AD:
Hosp Univ Marques de Valdecilla, Santander, Spain
Berron, SD:
Inst Catala Oncol, Girona, Spain
Perez, YF:
Hosp Univ Cent Asturias, Oviedo, Spain
Mata, JG:
Hosp Santa Maria Nai Ourense, Orense, Spain
Palomo, AG:
Complejo Asistencial Leon, Leon, Spain
Gregori, JG:
Fdn Inst Valenciano Oncol, Valencia, Spain
Pardo, PG:
Hosp Univ Vall dHebron, Barcelona, Spain
Manas, JJI:
Complejo Hosp Navarra, Pamplona, Spain
Hernandez, AL:
Hosp Clin Univ Valencia, Valencia, Spain
de Duenas, EM:
Consorcio Hosp & Prov Castellon, Castelln, Spain
Janez, NM:
Hosp Univ Ramn & Cajal, Madrid, Spain
Murillo, SM:
Hosp Arnau Vilanova, Lleida, Spain
Bofill, JS:
Hosp Univ Nuestra Senora de Valme, Seville, Spain
Aunon, PZ:
Hosp Univ La Paz, Madrid, Spain
Sanchez-Rovira, P:
Complejo Hosp Jaen, Jaen, Spain
Green Published
|