The third Advanced Breast Cancer consensus conference – ABC3 – took place last month at its regular Lisbon home. ABC is the world’s only international consensus meeting devoted to the care and treatment of women and men with locally advanced and metastatic breast cancer. At each ABC conference, a large panel of experts adds and refines guideline statements for managing patients, with the aim of promoting them around the world for all countries, including those that lack the resources of developed nations.
ABC has contributed greatly to a fundamental change in thinking about metastatic disease. No longer do oncologists raise doubts about the feasibility of guidelines for treating such patients – the argument that there are too many variables among individuals is not often heard now.
And the conference has done much to unite the various parties in the advanced breast cancer community – in particular, patients and advocates participate on an equal basis with physicians (including on the consensus panel) and there is also a wide spectrum of professional expertise, again on the panel and in the conference sessions. Psycho-oncology, supportive and palliative care, health economics and survivorship all had prominent positions alongside scientific progress, and a complementary stream for advocates also allowed networking among patient representatives from many countries.
It’s not easy to break down barriers, particularly between doctors and patients, and ABC co-chair, Fatima Cardoso, reminded delegates that the conference has a mission for all to be respectful of the views of others. She also introduced the first results from a major new study sponsored by Pfizer and supported by the European School of Oncology, entitled ‘Global status of advanced/metastatic breast cancer: 2005-2015 decade report’, in which patient care perspective and public understanding have been surveyed across as many as 34 countries, and which also reports on scientific progress (disclosure – I am on the steering committee for the report).
Big gaps remain in areas such as patient communication, involvement in decision-making, and public awareness, where many people still think metastatic breast cancer can be cured, and some prefer women not to talk about it. Dian ‘CJ’ Corneliussen-James, of US group METAvivor, told the audience that prejudice is still a major problem, and that metastatic patients can be made to feel unwelcome by some advocacy groups. There are indications that overall, quality of life may not have seen much improvement.
In the final session at ABC3, the consensus panel voted on new and changed statements in the guidelines, which will be published next year. There was heated discussion about some while others sailed through.
Briefly, there are important new statements concerning the use of objective benefit scales to assess drugs (e.g. from ESMO and ASCO), which may help to control costs, and on the need to design clinical trials that answer practical questions such as the sequence of using agents.
There are also new statements on survivorship, which is becoming more important as the number of women living with advanced disease for longer rises, and on several supportive care issues.
There has only been one new drug approved for the metastatic setting since ABC2, palbociclib, but new data on other drugs such as pertuzumab have changed some statements. The point was made in the conference that innovation in advanced breast cancer is now lagging other tumour types, such as lung cancer and melanoma.
Overall, the conference was notable for the continued integration of patients and those supporting patients into the programme. A highlight was Anna Craig, a young mother from the US, and her video, I am Anna, which was screened for delegates.