scholarly journals ABC4 Consensus: Assessment by a German Group of Experts

Breast Care ◽  
2018 ◽  
Vol 13 (1) ◽  
pp. 48-58 ◽  
Author(s):  
Nadia Harbeck ◽  
Diana Lüftner ◽  
Norbert Marschner ◽  
Michael Untch ◽  
Doris Augustin ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Advanced Breast Cancer ◽  
Growth Factor Receptor ◽  
Advanced Breast ◽  
Diagnosis And Treatment ◽  
Parp Inhibition ◽  
Molecular Testing ◽  
Her2 Positive ◽  
Global Alliance ◽  
Therapy Decision

The Advanced Breast Cancer Fourth Consensus (ABC4) on diagnosis and treatment of advanced breast cancer (ABC) again took place in Lisbon, on November 2-4, 2017, and was chaired by Fatima Cardoso, MD, PhD. This year's contents focused very much on new developments in the treatment of ABC. For example, the significance of inhibition of cyclin-dependent kinases 4 and 6 (CDK4/6) in hormone receptor (HR)-positive ABC, of dual antibody blockade in human epidermal growth factor receptor 2 (HER2)-positive ABC, and of poly(ADP-ribose) polymerase (PARP) inhibition in triple-negative ABC, as well as the potential therapeutic consequences, were discussed. Other key issues were BRCA-associated breast cancer, treatment of brain metastases, and personalized therapy decision-making using molecular testing (so-called ‘precision medicine'). As in past years, an important objective of the ABC conference was cooperation with representatives of patient organizations from around the world. This cooperation was further intensified during the ABC4. Following the main conference, the ‘Global Alliance' was founded, with the goal of publicizing and coordinating measures necessary worldwide from the patient advocates' standpoint. - The ABC consensus inevitably cannot accommodate country-specific needs, due to the truly global expert panel. Therefore, a working group of German breast cancer experts commented - as in the past years - on the on-site voting results by the ABC panelists upon which the final ABC4 consensus will be based, with particular consideration of the German guidelines on diagnosis and treatment of breast cancer for everyday treatment in Germany.

scholarly journals 4th International Consensus Conference on Advanced Breast Cancer (ABC4), Lisbon, November 4, 2017

2018 ◽  
Vol 78 (05) ◽  
pp. 469-480
Author(s):  
Michael Untch ◽  
Rachel Würstlein ◽  
Norbert Marschner ◽  
Diana Lüftner ◽  
Doris Augustin ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Clinical Practice ◽  
Advanced Breast Cancer ◽  
Metastatic Breast ◽  
Consensus Conference ◽  
Advanced Breast ◽  
Diagnosis And Treatment ◽  
Parp Inhibition ◽  
Molecular Testing ◽  
The World

AbstractThe fourth international advanced breast cancer consensus conference (ABC4) on the diagnosis and treatment of advanced breast cancer (ABC) headed by Professor Fatima Cardoso was once again held in Lisbon on November 2 – 4, 2017. To simplify matters, the abbreviation ABC will be used hereinafter in the text. In clinical practice, the abbreviation corresponds to metastatic breast cancer or locally far-advanced disease. This year the focus was on new developments in the treatment of ABC. Topics discussed included the importance of CDK4/6 inhibition in hormone receptor (HR)-positive ABC, the use of dual antibody blockade to treat HER2-positive ABC, PARP inhibition in triple-negative ABC and the potential therapeutic outcomes. Another major area discussed at the conference was BRCA-associated breast cancer, the treatment of cerebral metastasis, and individualized treatment decisions based on molecular testing (so-called precision medicine). As in previous years, close cooperation with representatives from patient organizations from around the world is an important aspect of the ABC conference. This cooperation was reinforced and expanded at the ABC4 conference. A global alliance was founded at the conclusion of the consensus conference, which aims to promote and coordinate the measures considered necessary by patient advocates worldwide. Because the panel of experts was composed of specialists from all over the world, it was inevitable that the ABC consensus also reflected country-specific features. As in previous years, a team of German breast cancer specialists who closely followed the consensus voting of the ABC panelists in Lisbon and intensively discussed the votes has therefore commented on the consensus in the context of the current German guidelines on the diagnosis and treatment of breast cancer 1, 2 used in clinical practice in Germany. The ABC consensus is based on the votes of the ABC panelists in Lisbon.

4. Internationale Konsensuskonferenz zum fortgeschrittenen Mammakarzinom (ABC4), Lissabon, 04.11.2017

2018 ◽  
Vol 15 (04) ◽  
pp. 238-249
Author(s):  
Michael Untch ◽  
Rachel Würstlein ◽  
Norbert Marschner ◽  
Diana Lüftner ◽  
Doris Augustin ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Advanced Breast Cancer ◽  
Advanced Breast ◽  
Parp Inhibition ◽  
Global Alliance ◽  
Diagnostik Und Therapie ◽  
Therapeutische Konsequenzen

ZusammenfassungVom 2. bis 4. November 2017 fand in Lissabon unter Leitung von Frau Professor Fatima Cardoso die 4. Internationale Konsensuskonferenz ABC4 (Advanced Breast Cancer Forth Consensus) zu Diagnostik und Behandlung des fortgeschrittenen Mammakarzinoms (ABC) statt. Zur Vereinfachung wird im weiteren Text von ABC gesprochen, was im klinischen Alltag der metastasierten Brustkrebserkrankung oder der lokal weit fortgeschrittenen Erkrankung entspricht. Der inhaltliche Schwerpunkt lag dieses Jahr auf neuen Entwicklungen in der Behandlung des ABC. Diskutiert wurden unter anderem der Stellenwert der CDK4/6-Inhibition beim hormonrezeptor(HR-)positiven ABC, die duale Antikörperblockade beim HER2-positiven ABC, die PARP-Inhibition beim BRC-Amutierten tripel-negativen und luminalen ABC sowie potenzielle therapeutische Konsequenzen. Ein weiterer Fokus lag auf dem BRCA-assoziierten Mammakarzinom, der Behandlung von Hirnmetastasen sowie der individualisierten Therapieentscheidung auf der Grundlage einer molekularen Testung (sog. Präzisionsmedizin). Wie schon in den vergangenen Jahren ist die Zusammenarbeit mit den Vertretern von Patientenorganisationen aus aller Welt ein wichtiges Anliegen der ABC-Konferenz. Sie wurde auf der ABC4-Konferenz weiter intensiviert. Im Anschluss an die Konsensuskonferenz wurde die „Global Alliance“ gegründet mit dem Ziel, die erforderlichen Maßnahmen aus Sicht der Patientenvertreterinnen weltweit zu propagieren und zu koordinieren. In den ABC-Konsensus fließen aufgrund des international zusammengesetzten Expertenpanels zwangsläufig länderspezifische Besonderheiten ein. Wie schon in den vergangenen Jahren hat daher eine Arbeitsgruppe deutscher Brustkrebsexperten, die die Konsensusabstimmung der ABC-Panelisten vor Ort mitverfolgt und intensiv diskutiert haben, diese unter Berücksichtigung der deutschen Leitlinien zu Diagnostik und Therapie des Mammakarzinoms 1 2 für den Therapiealltag in Deutschland kommentiert. Die Abstimmungsergebnisse der ABC-Panelisten in Lissabon sind die Grundlage des ABC-Konsensus.

scholarly journals Trastuzumab Emtansine With or Without Pertuzumab Versus Trastuzumab Plus Taxane for Human Epidermal Growth Factor Receptor 2–Positive, Advanced Breast Cancer: Primary Results From the Phase III MARIANNE Study

2017 ◽  
Vol 35 (2) ◽  
pp. 141-148 ◽  
Author(s):  
Edith A. Perez ◽  
Carlos Barrios ◽  
Wolfgang Eiermann ◽  
Masakazu Toi ◽  
Young-Hyuck Im ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Epidermal Growth Factor Receptor ◽  
Growth Factor ◽  
Epidermal Growth Factor ◽  
Advanced Breast Cancer ◽  
Growth Factor Receptor ◽  
Advanced Breast ◽  
Trastuzumab Emtansine ◽  
Her2 Positive ◽  
Epidermal Growth

Purpose Trastuzumab and pertuzumab are human epidermal growth factor receptor 2 (HER2) –targeted monoclonal antibodies, and trastuzumab emtansine (T-DM1) is an antibody–drug conjugate that combines the properties of trastuzumab with the cytotoxic activity of DM1. T-DM1 demonstrated encouraging efficacy and safety in a phase II study of patients with previously untreated HER2-positive metastatic breast cancer. Combination T-DM1 and pertuzumab showed synergistic activity in cell culture models and had an acceptable safety profile in a phase Ib and II study. Methods In the MARIANNE study, 1,095 patients with centrally assessed, HER2-positive, advanced breast cancer and no prior therapy for advanced disease were randomly assigned 1:1:1 to control (trastuzumab plus taxane), T-DM1 plus placebo, hereafter T-DM1, or T-DM1 plus pertuzumab at standard doses. Primary end point was progression-free survival (PFS), as assessed by independent review. Results T-DM1 and T-DM1 plus pertuzumab showed noninferior PFS compared with trastuzumab plus taxane (median PFS: 13.7 months with trastuzumab plus taxane, 14.1 months with T-DM1, and 15.2 months with T-DM1 plus pertuzumab). Neither experimental arm showed PFS superiority to trastuzumab plus taxane. Response rate was 67.9% in patients who were treated with trastuzumab plus taxane, 59.7% with T-DM1, and 64.2% with T-DM1 plus pertuzumab; median response duration was 12.5 months, 20.7 months, and 21.2 months, respectively. The incidence of grade ≥ 3 adverse events was numerically higher in the control arm (54.1%) versus the T-DM1 arm (45.4%) and T-DM1 plus pertuzumab arm (46.2%). Numerically fewer patients discontinued treatment because of adverse events in the T-DM1 arms, and health-related quality of life was maintained for longer in the T-DM1 arms. Conclusion T-DM1 showed noninferior, but not superior, efficacy and better tolerability than did taxane plus trastuzumab for first-line treatment of HER2-positive, advanced breast cancer.

scholarly journals Systemic Therapy for Patients With Advanced Human Epidermal Growth Factor Receptor 2–Positive Breast Cancer: American Society of Clinical Oncology Clinical Practice Guideline

2014 ◽  
Vol 32 (19) ◽  
pp. 2078-2099 ◽  
Author(s):  
Sharon H. Giordano ◽  
Sarah Temin ◽  
Jeffrey J. Kirshner ◽  
Sarat Chandarlapaty ◽  
Jennie R. Crews ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Targeted Therapy ◽  
Advanced Breast Cancer ◽  
Endocrine Therapy ◽  
Growth Factor Receptor ◽  
Advanced Breast ◽  
Line Treatment ◽  
First Line ◽  
Her2 Positive ◽  
American Society

Purpose To provide evidence-based recommendations to practicing oncologists and others on systemic therapy for patients with human epidermal growth factor receptor 2 (HER2) –positive advanced breast cancer. Methods The American Society of Clinical Oncology convened a panel of medical oncology, radiation oncology, guideline implementation, and advocacy experts and conducted a systematic literature review from January 2009 to October 2012. Outcomes of interest included overall survival, progression-free survival (PFS), and adverse events. Results A total of 16 trials met the systematic review criteria. The CLEOPATRA trial found survival and PFS benefits for docetaxel, trastuzumab, and pertuzumab in first-line treatment, and the EMILIA trial found survival and PFS benefits for trastuzumab emtansine (T-DM1) in second-line treatment. T-DM1 also showed a third-line PFS benefit. One trial reported on duration of HER2-targeted therapy, and three others reported on endocrine therapy for patients with HER-positive advanced breast cancer. Recommendations HER2-targeted therapy is recommended for patients with HER2-positive advanced breast cancer, except for those with clinical congestive heart failure or significantly compromised left ventricular ejection fraction, who should be evaluated on a case-by-case basis. Trastuzumab, pertuzumab, and taxane for first-line treatment and T-DM1 for second-line treatment are recommended. In the third-line setting, clinicians should offer other HER2-targeted therapy combinations or T-DM1 (if not previously administered) and may offer pertuzumab, if the patient has not previously received it. Optimal duration of chemotherapy is at least 4 to 6 months or until maximum response, depending on toxicity and in the absence of progression. HER2-targeted therapy can continue until time of progression or unacceptable toxicities. For patients with HER2-positive and estrogen receptor–positive/progesterone receptor–positive breast cancer, clinicians may recommend either standard first-line therapy or, for selected patients, endocrine therapy plus HER2-targeted therapy or endocrine therapy alone.

scholarly journals Survival before and after the introduction of pertuzumab and T-DM1 in HER2-positive advanced breast cancer, a study of the SONABRE Registry

2021 ◽  
Author(s):  
Khava I. E. Ibragimova ◽  
Sandra M. E. Geurts ◽  
Sander Croes ◽  
Frans Erdkamp ◽  
Joan B. Heijns ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Targeted Therapy ◽  
Advanced Breast Cancer ◽  
Proportional Hazards ◽  
Survival Rates ◽  
Growth Factor Receptor ◽  
Cox Proportional Hazards ◽  
Advanced Breast ◽  
Her2 Positive ◽  
Before And After

Abstract Purpose Immediate and proper implementation of a new and more potent therapy is important to ensure that the patient achieves the best possible outcome. This study aimed to examine whether the real-world overall survival (OS) has improved in patients with human epidermal growth factor receptor 2-positive (HER2 +) advanced breast cancer (ABC) since the market release of pertuzumab and T-DM1. Furthermore, we aimed to assess the implementation and survival rates per hormone receptor (HR) subtype. Patients and methods We included 493 systemically treated patients consecutively diagnosed with HER2 + ABC in 2008–2017 from the SOutheast Netherlands Advanced BREast cancer (SONABRE) Registry. Median OS was obtained using the Kaplan–Meier method and differences between periods (2008–2012 versus 2013–2017) were tested using multivariable Cox proportional hazards regression modeling. The 3-year implementation rates were estimated for any HER2-targeted therapy, pertuzumab, and T-DM1 by using the competing risk method and calculated from the date of diagnosis of ABC to start of HER2-targeted therapy of interest. Results The median OS in 2008–2012 versus 2013–2017 was 28.3 versus 39.7 months in all patients (adjusted hazard ratio (adjHR) 0.85, 95%CI 0.66–1.08), 29.9 versus 36.3 months in patients with HR + /HER2 + disease (adjHR 0.97, 95%CI 0.72–1.32), and 22.7 versus 40.9 months in patients with HR-/HER2 + disease (adjHR 0.59, 95%CI 0.38–0.92). Any HER2-targeted therapy was used in 79% of patients in 2008–2012 and in 84% in 2013–2017. The use of pertuzumab and T-DM1 in 2013–2017 was 48% and 29%, respectively. For patients diagnosed with HR + /HER2 + and HR-/HER2 + disease, implementation rates in 2013–2017 were , respectively, 77% and 99% for any HER2-targeted therapy, 38% and 69% for pertuzumab, and 24% and 40% for T-DM1. Conclusion The survival of patients with HER2 + ABC improved since the introduction of pertuzumab and T-DM1. There is room for improvement in implementation of these HER2-targeted therapies, especially in patients with HR + /HER2 + disease.

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