What does the future hold for treating patients with locally advanced breast cancer?

Treating patients with locally advanced inoperable breast cancer is an extremely difficult task. The overwhelming majority of patients treated for this disease suffer relapse and, despite the best multimodal treatment, do not survive. There is a medical need to examine current and potential treatments, and EORTC researchers have recently published an article in Nature Reviews Clinical Oncology concerning this topic.

Dr. Konstantinos Tryfonidis, EORTC Clinical Research Physician and lead author of this review says, “Locally advanced breast cancer is a term that includes a wide variety of breast tumors ranging from large operable cancers with extensive nodal involvement to inflammatory breast carcinomas. Indeed, some large operable breast tumors could fit in these categories, but we decided to limit our discussion to inoperable cancers. So, we are addressing, specifically, inoperable cases due to extensive skin involvement, fixed or very bulky axillary nodal disease and/or supraclavicular or internal mammary nodal involvement or tumors with inflammatory elements.”

Dr. Fatima Cardoso of the Champalimaud Clinical Centre in Lisbon, Portugal, and corresponding author of this review points out, “The prognosis for patients with these tumors is often unfavorable, but advances in therapy offer some hope. Although not very often in developed countries, locally advanced inoperable breast cancer is still a challenging clinical problem in developing countries, particularly those without screening nor education/awareness programs. Managing the treatment of patients with this disease requires a multidisciplinary approach, and such an approach mandates a coordinated treatment schedule and close cooperation between medical, surgical and radiation oncologists. More and more, locally advanced inoperable breast cancer is drawing the interest of the oncology community, and as it was one of the main topics discussed at the Advanced Breast Cancer Symposium and Consensus Meeting 2 (ABC2) in Lisbon in November 2013”.

Tryfonidis et al. discuss perspectives and future directions for the management of locally advanced breast cancer in Nature Reviews Clinical Oncology, and they see a need for not only standardizing treatment for this disease, but also for developing new therapies that could substantially improve outcome. They hope that these achievements might also serve as a model for improving the management of other disease stages and settings.

The EORTC has a number of planned and ongoing trials for patients with breast cancer. These include:

• EORTC 10085p – Clinical and biological characterization of Male Breast Cancer: an international EORTC, BIG, TBCRC and NABCG intergroup study.
• EORTC 1307 – A phase 3 randomized trial of Niraparib versus Physician’s choice in patients with germline BRCA mutation and previously treated breast cancer
• EORTC 75111 – Pertuzumab + trastuzumab (PH) versus PH plus metronomic chemotherapy (PHM) in the elderly HER2+ metastatic breast cancer population who may continue on T-DM1 alone following disease progression while on PH/PHM: an open-label multicentre randomized phase II selection trial of the EORTC Elderly Task Force and Breast Cancer Group
• EORTC 90091 – TRastuzumab in HER2-negative Early breast cancer as Adjuvant Treatment for Circulating Tumor Cells (CTC) (“Treat CTC” trial)
• EORTC 1401 – EORTC Management of low risk ductal carcinoma in situ (low-risk DCIS): a randomized, multicenter, non-inferiority trial, between standard therapy approach versus active surveillance (The LORD trial) in collaboration with BOOG.

John Bean, PhD
EORTC, Medical Science Writer