Europe: Twelve recommendations for treatment of advanced breast cancer

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The treatment of advanced metastatic breast cancer is an art. Advanced breast cancer almost no standardized treatment, especially in the fir


The treatment of advanced metastatic breast cancer is an art. Advanced breast cancer almost no standardized treatment, especially in the first rescue treatment failure, therefore clinical medical experts focus more wisdom, balance, the most suitable choice of treatment strategy.

Because most of the patients with advanced stage can not be cured, it can improve their quality of life and prolong their survival time. How to give the most reasonable and effective treatment for patients with advanced, rather than test clinicians technology, rather than experience their souls, because they have to pay more attention and care. Based on this, the ESO- MBC working group experts drafted twelve recommendations on the diagnosis and treatment of advanced metastatic breast cancer.

1 requires a multidisciplinary collaboration team, including oncology, radiation therapy, surgery, imaging, palliative care, psychosocial experts to participate in treatment.

2 once diagnosed, the patient should be individualized psychological counseling, as soon as possible to control their symptoms, at the same time began to support treatment, which should be an important component of comprehensive treatment of advanced patients.

3 after the diagnosis and comprehensive evaluation of the condition, to discuss the more realistic treatment goals, and invite patients and their families to participate in the development of all treatment options.

4 in particular, patients with a single lesion or regional recurrence can be fully controlled and can survive for long periods of time. For this group of patients should be given a more active multidisciplinary comprehensive treatment, to promote its scientific clinical trials.

5 the following information should be collected: history, physical examination, blood biochemical examination, chest and abdomen and bone imaging. Tumor markers can not be used as diagnostic criteria, but they can be used to evaluate the therapeutic effect, especially for the patients with unknown lesions.

6 treatment plans to consider the following factors: endocrine therapy sensitivity, HER2 status, menstrual status, disease free survival, previous treatment and curative effect of tumor burden (metastasis and number), biological age, patients with coexisting disease, physical condition, whether it is necessary to control and rapid tumor symptoms, social economic and psychological factors and with the wishes of the individual and local treatment conditions of patients.

7 for hormone receptor positive patients, endocrine therapy is preferred, unless there is a clear evidence of endocrine therapy. Postmenopausal patients with reasonable first-line endocrine therapy for aromatase inhibitors (AI) or tamoxifen, premenopausal patients for tamoxifen combined with ovarian function suppression or resection, unless the tamoxifen resistance. No standard drug options after AI treatment failure. It is not clear whether the application of endocrine therapy can be used to rescue the patients after chemotherapy. Chemotherapy should not be combined with endocrine therapy.

The failure of the 8 after endocrine therapy, HER2 positive patients should be given early treatment with trastuzumab. Endocrine therapy combined with trastuzumab therapy is still in the experimental stage, is not the standard scheme. Progress on trastuzumab treated patients, treatment is still in research.

9 chemotherapy is a combination or sequential, we must take into account the sixth factors, with special emphasis on the efficacy and quality of life as soon as possible to improve. The overall survival of most patients was similar to that of sequential and combination therapy. The application time limit and the number of programs should be individualized according to the patient's own situation.

10 to encourage patients to actively participate in the design of scientific prospective, independent clinical trials, the trial treatment program must have a clear scientific basis, the choice of evidence-based medicine research results.

11 medical institutions and individuals always weigh the costs and benefits of patient care, and patient health, survival and quality of life are always the first consideration.

12 formal or informal assessment of quality of life may provide useful information that should be encouraged to incorporate this information into the development of treatment plans, as well as the implementation, termination, and change of treatment strategies.

(Wu Shikai)

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