Tag Archives: advanced breast cancer

ABC steps up to fill the gaps in metastatic breast cancer care

Marc Beishon

Marc Beishon

 

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.

Dian ‘CJ’ Corneliussen-James spoke about prejudice still affecting metastic breast cancer patients

Dian ‘CJ’ Corneliussen-James spoke about prejudice still affecting metastatic breast cancer patients

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.

The consensus panel vote on new and changed statements in the guidelines

The consensus panel vote on new and changed statements in the guidelines

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.

See @ESOncology and #ABCLisbon for tweets.

Smoke gets in your eyes

Simon Crompton

Simon Crompton

The title of Europa Donna’s annual London symposium last week was “New directions in breast cancer”. By the end of the evening, possible new directions were clear, but the route to take was not.

One of the two speakers was Daniel Leff, a cancer surgeon from Imperial College London, who addressed the difficulties of defining the correct margins when surgically removing breast cancer. The object had to be, he said, reducing the chances of reoperation.

He tantalised the audience with the question: “Can surgical smoke be informative?”

Potential of spectrometer analysis

Researchers at Imperial have used mass spectrometers to analyse the smoke arising from tissue incision with electrosurgical knives – a technique known as Rapid Evaporative Ionisation Mass Spectrometry (REIMS). Different types of cell produce different chemical concentrations when burned, so the chemical profile can indicate whether the tissue being cut is cancerous or not.

Identification of cancerous tissue using the technique during surgery, said Leff, was 93% accurate.

It’s a truly impressive technological development, that has potential to radically reduce reoperation rates for breast cancer.

The cost question

But how much did the machinery cost, asked a member of the audience? Half a million pounds, answered Leff. And how much did a pathologist cost? The answer was not given, but the point was made…

Pathologists already have advanced (and cheaper) techniques which can accurately indicate to surgeons which areas are cancerous and which are not. The question, said audience members, was why they were not being used. Leff himself acknowledged that pathology analysis using frozen section and touch imprint cytology were highly effective ways of determining the extent of breast disease and reducing the need for re-excision. But they are not widely used in the UK.

Novelty intoxication

On the systemic therapy side, Stephen Johnston, Professor of Breast Cancer Medicine at the Royal Marsden Hospital, spoke of the real promise of the drug Palbociclib as a first-line treatment for ER-positive breast cancer, and (in combination with Fulvestrant) as a second-line treatment as well. The cost of Palbociclib? Around £90,000 for one year’s treatment. The pressing question of how such expensive drugs are to be made widely available was raised, but not addressed.

New directions in breast cancer are exciting, involving, often inspiring. But we know how easy it is to become intoxicated with novelty and infatuated with technology. Sometimes, it isn’t new directions we need to hear about, but what is already here but under-utilised – and how we can best use what is proven, affordable and practicable to benefit the greatest number of women possible, as soon as possible.

Europa Donna, the European Breast Cancer Coalition, has a Facebook page.

 

 

 

 

 

Only one day for advanced breast cancer

Marc Beishon

Marc Beishon

As October draws to a close, and another awareness month for the breast cancer movement, there is some good news for those living with or supporting those with advanced or metastatic breast cancer. This year there has been more emphasis on advanced disease amid the sea of pink ribbons and fundraising campaigns, which have tended to focus on early and curative stages of breast cancer, leaving many women (and some men) isolated from both the advocacy and medical communities.

This is particularly so in the US, where the pink ribbon campaigns were first launched. For four years, there has been a national metastatic breast cancer awareness day (13 October this year), and it has now attracted attention. Several national media outlets have highlighted the issues facing those with advanced disease, such as the Chicago Tribune and SFGate and there was an item on the TV programme, Good Morning America. Australia’s Breast Cancer Network joined in this year for the first time, but under the name of secondary breast cancer awareness.

Women speak out

A patient's blog

A patient’s blog

Advocacy groups such as the Metastatic Breast
Cancer Network
and METAvivor have been instrumental in the US in raising the profile of
advanced disease, and women with metastatic disease are taking to blogs to write about their experiences and how they feel about the lack of interest from the wider community – for example here and here. They are not only powerful testimonies but also calls to action for progress for their incurable condition, not least just being heard.

mbc coverAgain in the US, industry and advocates have come together in the Metastatic Breast Cancer Alliance to report on the status of research on advanced breast cancer, the quality of life of patients, what information and support is available, and public awareness. Not least, they aim to find out much more about how many people have metastatic disease. Their report (left) just published with the support of the Avon Foundation, is probably the most comprehensive review so far of these issues – and the agenda for the work needed is challenging, to say the least.

New survey data in the US has also informed Pfizer’s Breast cancer: a story half told initiative – as the company says: “Many people know little to nothing about metastatic breast cancer.” It joins a similar initiative sponsored by Novartis, Here & Now, which launched in Europe last year.

The advocacy movement in the US is particularly vocal, but if it has struggled to be heard, imagine how difficult things are in many other countries. There is an urgent need for much more to be done globally across the spectrum of issues – standards of care, research, and support for those with metastatic and locally advanced breast cancer.

ABC guidelines out

abc2The latest updated international guidelines (right) that cover this spectrum from ABC, the Advanced Breast Cancer conference, aim to help fill the gaps by applying current knowledge to patient care. The conference, held by the European School of Oncology (ESO) and the European Society for Medical Oncology (ESMO), is the only global event that brings together health professionals, researchers and advocates to publish such guidelines, which have recently been published in The Breast and Annals of Oncology – the full paper is free to download via the ABC site.

Progress in treating advanced breast cancer remains frustratingly slow, and awareness, support, and research funding are still low. The ethos of the ABC conference is to build on the momentum from the latest initiatives and especially to unite experience and research at a global level, and we encourage all to download the guidelines and help spread the word.

abcinfo2