According to a panel of experts from the Advanced Breast Cancer Sixth International Consensus Conference (ABC 6) patients with two of the three most common forms of advanced breast cancer now have an average survival time of at least five years.
When breast cancer spreads to other parts of the body (called metastatic or advanced breast cancer), it becomes more difficult to treat and the average survival time is therefore low. However, in the past decade, more research has been done on advanced breast cancer (ABC), meaning doctors now know a lot more about how to treat the disease.
In a session agreeing on new guidelines for treating advanced breast cancer, experts said more work is needed to find treatments that are effective for the third type of ABC (called triple negative ABC), which keeps average survival times lower. .
The most common subtype of ABC is known as hormonally dependent or estrogen receptor positive (ER+) because its growth is fueled by the hormone estrogen. Another subtype is known as HER2+ because the cancer cells make too much of a protein known as HER2, which stimulates their growth. Over the past decade, median survival for these two subtypes of ABC, which together account for 85% of cases, has increased from just one or two years to five years. This means that half of the patients with these cancers can live longer than five years, and some even ten years.
The third subtype, known as triple-negative cancer because it is not fueled by estrogen and does not overproduce HER2, has fewer treatment options and patients have a poorer survival as a result. In the past few years, hopes for this subtype have also increased, with two new treatments showing some survival benefit. In the new guidelines agreed at ABC 6, experts say patients with this subtype should have access to these new drugs, sacituzumab govitecan, and anti-PD-L1 agents, especially pembrolizumab.
A key goal of the Advanced Breast Cancer Conferences and the ABC Global Alliance, enshrined in the ABC Global Charter, is to double the survival of patients with the disease by 2025.
We’ve taken a big step toward our goal of doubling the average patient survival times because we’ve now achieved this in two of the three subtypes of advanced breast cancer.
This disease is still incurable, but we have come a long way and this progress makes me hopeful. It means that for most patients they have two or three extra years of life, with a good quality of life as well. Survival has also improved for patients with triple-negative disease, but we need to do more for these patients, especially as it tends to affect younger people who often have young children to care for.”
Professor Fatima Cardoso, Chair of the ABC 6 Conference and of the ABC Global Alliance, Director of the Breast Unit of the Champalimaud Cancer Center in Lisbon, Portugal
The Advanced Breast Cancer International Consensus Conferences have been running for ten years and meet every two years to share and discuss the latest research on ABC, and to update international guidelines on how best to treat patients. The new guidelines from this year’s meeting will be published in early 2022.
Professor Cardoso added: “Ten years ago there was a terrible lack of research into helping patients with advanced breast cancer and as a result we had to base most of our recommendations on expert opinion.
“We’ve worked hard to drive the research community around this issue and we’ve made great strides over the past decade. This year, most of our recommendations for treating ABC are now based on the best possible scientific evidence, called Level 1. This is good news for patients as they can rest assured that the treatments they receive are backed by the best science and have the best chance of keeping them healthy for longer.”
Ms Renata Haidinger, co-chair of ABC 6, chair of the German Breast Cancer Association and a breast cancer survivor since 2000, said: “Thanks to Professor Cardoso’s leadership and determination, the ABC conferences and the ABC Global Alliance have made a huge contribution to improvements in the understanding, treatment and survival of advanced breast cancer Over the past ten years this has had a huge impact on the lives of patients and I have no doubt that as we continue our work we will make further improvements to help more patients to help with metastatic disease survive for five years and beyond.”
The new ABC guidelines also emphasized:
Breast cancer that has limited metastatic lesions and is sensitive to treatment (called oligometastatic disease) “has the potential for long survival or cure with a multidisciplinary approach.”
Prof Cardoso said: “This is a message of hope. Thanks to better systemic treatments and radiotherapy, we can locally treat different types of metastases without causing many other health problems, and we can achieve long, complete remissions. We can almost talk about a cure even though we have it.” can never promise, and this is only true for a minority of patients.” Cancer and treatment-related cognitive impairment (CRCI) or “onco-brain” is a real condition that involves physical changes in the brain as a result of cancer treatment, and should not be dismissed as “just in the mind”. For the first time, the guidelines define the condition and make recommendations for managing it, for example through routine exercise and screening for factors that can be improved or corrected, such as drug side effects, emotional stress, depression or anxiety, alcohol use and vitamin deficiencies. The guidelines state for the first time that informal carers also need support. The experts argue that working informal carers are protected against discrimination in the workplace, and that they have the right to continued employment and reasonable accommodation, such as flexible working, to accommodate their caring responsibilities.
There are no reliable figures on the number of women (and men) living with advanced breast cancer. However, there are more than two million new cases of breast cancer each year in the world and 0.6 million deaths. About 5-10% of cases are either locally advanced or metastatic at diagnosis, and these figures reach nearly 80% in developing countries. About a third of all early breast cancers will spread even with the best care.
Global Alliance for Advanced Breast Cancer (ABC)