11 research outputs found
Guideline implementation for breast healthcare in low- and middle-income countries: Treatment resource allocation
No full textA key determinant of breast cancer outcome is the degree to which newly diagnosed cancers are treated correctly in a timely fashion. Available resources must be applied in a rational manner to optimize population-based outcomes. A multidisciplinary international panel of experts addressed the implementation of treatment guidelines and developed process checklists for breast surgery, radiation treatment, and systemic therapy. The needed resources for stage I, stage II, locally advanced, and metastatic breast cancer were outlined, and process metrics were developed. The ability to perform modified radical mastectomy is the mainstay of locoregional treatment at the basic level of breast healthcare. Radiation therapy allows for consideration of breast-conserving therapy, postmastectomy chest wall irradiation, and palliation of painful or symptomatic metastases. Systemic therapy with cytotoxic chemotherapy is effective in the treatment of all biologic subtypes of breast cancer, but its provision is resource intensive. Although endocrine therapy requires few specialized resources, it requires knowledge of hormone receptor status. Targeted therapy against human epidermal growth factor receptor 2 (anti-HER-2) is very effective in tumors that overexpress HER-2-neu receptors, but cost largely prevents its use in resource-limited environments. Incremental allocation of resources can help address economic disparities and ensure equity in access to care. Checklists and allocation tables can support the objective of offering optimal care for all patients. The use of process metrics can facilitate the development of multidisciplinary, integrated, fiscally responsible, continuously improving, and flexible approaches to the global enhancement of breast cancer treatment. © 2008 American Cancer Society.Anderson BO, 2006, BREAST J, V12, pS3, DOI 10.1111-j.1075-122X.2006.00199.x; Anderson BO, 2006, BREAST J, V12, pS54, DOI 10.1111-j.1075-122X.2006.00203.x; Anderson Benjamin O, 2003, Breast J, V9 Suppl 2, pS42, DOI 10.1046-j.1524-4741.9.s2.3.x; Bese NS, 2008, CANCER-AM CANCER SOC, V113, P2305, DOI 10.1002-cncr.23838; Carlson Robert W, 2007, J Natl Compr Canc Netw, V5, P246; Carlson Robert W, 2003, Breast J, V9 Suppl 2, pS67, DOI 10.1046-j.1524-4741.9.s2.6.x; Abe O, 2005, LANCET, V366, P2087; Abe O, 2005, LANCET, V365, P1687; El Saghir NS, 2008, CANCER-AM CANCER SOC, V113, P2315, DOI 10.1002-cncr.23836; El Saghir Nagi S, 2007, Int J Surg, V5, P225, DOI 10.1016-j.ijsu.2006.06.015; Eniu A, 2006, BREAST J, V12, pS38, DOI 10.1111-j.1075-122X.2006.00202.x; Goldhirsch A, 2007, ANN ONCOL, V18, P1133, DOI 10.1093-annonc-mdm271; Malin JL, 2006, J CLIN ONCOL, V24, P626, DOI 10.1200-JCO.2005.03.3365; Pavlidis N, 2007, ANN ONCOL, V18, P1759, DOI 10.1093-annonc-mdm362; Rugo HS, 2008, ANN ONCOL, V19, P16, DOI 10.1093-annonc-mdm282; Schwartsmann G, 2001, J CLIN ONCOL, V19, p118S; Shyyan R, 2006, BREAST J, V12, pS27, DOI 10.1111-j.1075-122X.2006.00201.x; Singletary SE, 2002, J CLIN ONCOL, V20, P3628, DOI 10.1200-JCO.2002.02.026; Smith RA, 2006, BREAST J, V12, pS16, DOI 10.1111-j.1075-122X.2006.00200.x; Vorobiof DA, 2001, J CLIN ONCOL, V19, p125S; World Health Organization, 2002, EX SUMM NAT CANC CON29262
Locally advanced breast cancer: Treatment guideline implementation with particular attention to low- and middle-income countries
No full textThe management of locally advanced breast cancer (LABC) is guided by scientific advances but is limited by local resources and expertise. LABC remains very common in low-resource countries. The Systemic Therapy Focus Group met as part of the Breast Health Global Initiative (BHGI) Summit in Budapest, Hungary, in October 2007 to discuss management and implementation of primary systemic therapy (PST) for LABC. PST is standard treatment for large operable breast cancer in enhanced-resource settings and, in all resource settings, should be standard treatment for inoperable breast cancer and for LABC. Standard PST includes anthracycline-based chemotherapy. The addition of sequential taxanes after anthracycline improves pathologic responses and breast-conservation rates and is appropriate at enhanced-resource levels; however, costs and lack of clear survival benefit do not justify their use at limited-resource levels. It remains to define better the role of endocrine therapy as PST, but it is acceptable in elderly women. Aromatase inhibitors have produced better results than tamoxifen in postmenopausal patients and are used in enhanced-resource settings. The less expensive tamoxifen remains useful in low-resource countries. Trastuzumab combined with chemotherapy yields high pathologic response rates in patients with HER2-neu-overexpressing tumors; its use in low-resource countries is limited by high costs. Most studies on PST of LABC were conducted in countries with enhanced resources. BHGI encourages conducting clinical trials in countries with limited resources. © 2008 American Cancer Society.Agarwal G, 2007, WORLD J SURG, V31, P1031, DOI 10.1007-s00268-005-0585-9; Albain KS, 2002, P AN M AM SOC CLIN, V21, p37a; Anderson BO, 2008, CANCER, V113, P2221, DOI 10.1002-cncr.23844; Anderson BO, 2006, BREAST J, V12, pS3, DOI 10.1111-j.1075-122X.2006.00199.x; ANGELL M, 2004, DRUG PRICES PHARM TR; Bear HD, 2003, J CLIN ONCOL, V21, P4165, DOI 10.1200-JCO.2003.12.005; Bear HD, 2006, J CLIN ONCOL, V24, P2019, DOI 10.1200-JCO.2005.04.1665; Bonadonna G, 1998, J CLIN ONCOL, V16, P93; Burstein HJ, 2003, J CLIN ONCOL, V21, P46, DOI 10.1200-JCO.2003.03.124; Buzdar AU, 1999, J CLIN ONCOL, V17, P3412; Buzdar AU, 2007, CLIN CANCER RES, V13, P228, DOI 10.1158-1078-0432.CCR-06-1345; Buzdar AU, 2005, J CLIN ONCOL, V23, P3676, DOI 10.1200-JCO.2005.07.032; Buzdar AU, 2007, CANCER, V110, P2394, DOI 10.1002-cncr.23083; Cataliotti L, 2007, EUR J CANCER, V43, P660, DOI 10.1016-j.ejca.2006.12.008; Cataliotti L, 2006, CANCER, V106, P2095, DOI 10.1002-cncr.21872; CLIFFORD KSC, 1999, RAD ONCOLOGY MANAGEM, P369; Davidson NE, 2005, J NATL CANCER I, V97, P159; Dawood S, 2007, CANCER, V110, P1195, DOI 10.1002-cncr.22895; Eiermann W, 2001, ANN ONCOL, V12, P1527, DOI 10.1023-A:1013128213451; El Saghir Nagi S, 2007, Int J Surg, V5, P225, DOI 10.1016-j.ijsu.2006.06.015; Ellis MJ, 2001, J CLIN ONCOL, V19, P3808; Estevez LG, 2004, CLIN CANCER RES, V10, P3249, DOI 10.1158-1078-0432.CCR-03-0133; Fisher B, 1998, J CLIN ONCOL, V16, P2672; Fregene A, 2005, CANCER-AM CANCER SOC, V103, P1540, DOI 10.1002-cncr.20978; FREUDENHEIM M, 2002, NY TIMES 1227; Goble S, 2003, SURG CLIN N AM, V83, P943, DOI 10.1016-S0039-6109(03)00071-9; Green MC, 2005, J CLIN ONCOL, V23, P5983, DOI 10.1200-JCO.2005.06.232; Greene FL, 2002, AJCC CANC STAGING MA; HALYARD MY, 2006, J CLIN ONCOL, V24; Heys Steven D, 2002, Clin Breast Cancer, V3 Suppl 2, pS69, DOI 10.3816-CBC.2002.s.015; Heys SD, 2005, BREAST CANCER RES TR, V90, P169, DOI 10.1007-s10549-004-1001-0; Hortobagyi Gabriel N, 2005, Clin Breast Cancer, V6, P391, DOI 10.3816-CBC.2005.n.043; Hurley J, 2006, J CLIN ONCOL, V24, P1831, DOI 10.1200-JCO.2005.02.8886; Hurley Judith, 2005, Clin Breast Cancer, V5, P447, DOI 10.3816-CBC.2005.n.003; Joensuu H, 2006, NEW ENGL J MED, V354, P809, DOI 10.1056-NEJMoa053028; Kaufmann M, 2003, J CLIN ONCOL, V21, P2600, DOI 10.1200-JCO.2003.01.136; Mauri D, 2005, J NATL CANCER I, V97, P188; Mauriac L, 2002, ANN ONCOL, V13, P293, DOI 10.1093-annonc-mdf037; Mauriac L, 1999, ANN ONCOL, V10, P47, DOI 10.1023-A:1008337009350; Mazouni C, 2007, ANN ONCOL, V18, P874, DOI 10.1093-annonc-mdm008; *NCCN, BREAST CANC 2008 V2; *NIH, 2007, TRAST 6 MONTHS 1 YEA; ONYANGO M, 2007, BREAST HLTH GLOB IN; Parkes A, 2006, HEALTH PLACE, V12, P1, DOI 10.1016-j.healthplace.2004.03.004; Pestalozzi BC, 2005, ANN ONCOL, V16, P7, DOI 10.1093-annonc-mdi825; Rastogi P, 2008, J CLIN ONCOL, V26, P778, DOI 10.1200-JCO.2007.15.0235; Rodriguez-Cuevas S, 2001, CANCER, V91, P863, DOI 10.1002-1097-0142(20010215)91:4863::AID-CNCR10743.0.CO;2-Y; Sachelarie I, 2006, ONCOLOGIST, V11, P574, DOI 10.1634-theoncologist.11-6-574; Semiglazov VF, 2007, CANCER-AM CANCER SOC, V110, P244, DOI 10.1002-cncr.22789; Shyyan R, 2008, CANCER-AM CANCER SOC, V113, P2257, DOI 10.1002-cncr.23840; SILVA OE, 2005, BREAST CANC PRACTICA, P251; SINGLETARY SE, 2002, J CLIN ONCOL, V20, P3629; Smigal C, 2006, CA-CANCER J CLIN, V56, P168; Smith IC, 2002, J CLIN ONCOL, V20, P1456, DOI 10.1200-JCO.20.6.1456; Smith IE, 2005, J CLIN ONCOL, V23, P5108, DOI 10.1200-JCO.2005.04.005; Thomas E, 2004, J CLIN ONCOL, V22, P2294, DOI 10.1200-JCO.2004.05.207; *US FDA, DRUG PAT; von Minckwitz G, 2007, EXPERT OPIN PHARMACO, V8, P485, DOI 10.1517-14656566.8.4.485; WAGSTAFF A, 2006, CANC WORLD; Wolmark N, 2001, J NATL CANC I MONOGR, V30, P96; World Health Organization, 2005, ESS MED WHO MOD LIST; ZIELINSKI S, 2005, J NATL CANCER I, V97, P15726252
Breast cancer management in low resource countries (LRCs): Consensus statement from the Breast Health Global Initiative
No full textThe Breast Health Global Initiative (BHGI) brought together international breast cancer experts to discuss breast cancer in low resource countries (LRCs) and identify common concerns reviewed in this consensus statement. There continues to be a lack of public and health care professionals'awareness of the importance of early detection of breast cancer. Mastectomy continues to be the most common treatment for breast cancer; and a lack of surgeons and anesthesia services was identified as a contributing factor in delayed surgical therapy in LRCs. Where available, radiation therapy is still more likely to be used for palliation rather than for curative treatment. Tumor receptor status is often suboptimally performed due to lack of advanced pathology services and variable quality control of tissue handling and processing. Regional pathology services can be a cost-effective approach and can serve as reference, training and research centers. Limited availability of medical oncologists in LRCs often results in non-specialist providing chemotherapeutic services, which requires additional supervision and training. Palliative care is an emerging field in LRCs that requires investment in training and nfrastructure development. A commitment and investment in the development of breast cancer care services by LRC governments and health authorities remains a critical need in LRCs. © 2011 Elsevier Ltd.Adams EJ, 2008, BRIT J RADIOL, V81, P304, DOI 10.1259-bjr-77023750; Adebamowo C A, 2000, West Afr J Med, V19, P179; Adebamowo CA, 2008, BREAST CANCER RES TR, V110, P183, DOI 10.1007-s10549-007-9694-5; Adesunkanmi ARK, 2006, BREAST, V15, P399, DOI 10.1016-j.breast.2005.06.008; Agarwal G, 2009, WORLD J SURG, V33, P2069, DOI 10.1007-s00268-009-0150-z; Agarwal T, 2003, EUR J CANCER, V39, P52, DOI 10.1016-S0959-8049(02)00459-8; Ajekigbe A T, 1991, Clin Oncol (R Coll Radiol), V3, P78, DOI 10.1016-S0936-6555(05)81167-7; Akarolo-Anthony SN, 2010, BREAST CANCER RES, V12, DOI 10.1186-bcr2737; Akhigbe AO, 2009, BMC CANCER, V9, DOI 10.1186-1471-2407-9-203; American Cancer Society, 2007, GLOB CANC FACTS FIG; Anderson BO, 2008, CANCER, V113, P2221, DOI 10.1002-cncr.23844; Anderson BO, 2006, BREAST J, V12, pS3, DOI 10.1111-j.1075-122X.2006.00199.x; 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The alteration of gray matter volume and cognitive control in adolescents with internet gaming disorder
No full textObjective: Internet gaming disorder (IGD) has been investigated by many behavioral and neuroimaging studies, for it has became one of the main behavior disorders among adolescents. However, few studies focused on the relationship between alteration of gray matter volume (GMV) and cognitive control feature in IGD adolescents. Methods: Twenty-eight participants with IAD and twenty-eight healthy age and gender matched controls participated in the study. Brain morphology of adolescents with IGD and healthy controls was investigated using an optimized voxel-based morphometry (VBM) technique. Cognitive control performances were measured by Stroop task, and correlation analysis was performed between brain structural change and behavioral performance in IGD group. Results: The results showed that GMV of the bilateral anterior cingulate cortex (ACC), precuneus, supplementary motor area (SMA), superior parietal cortex, left dorsal lateral prefrontal cortex (DLPFC), left insula, and bilateral cerebellum decreased in the IGD participants compared with healthy controls. Moreover, GMV of the ACC was negatively correlated with the incongruent response errors of Stroop task in IGD group. Conclusion: Our results suggest that the alteration of GMV is associated with the performance change of cognitive control in adolescents with IGD, which indicating substantial brain image effects induced by IGD
A phase II randomized trial of cobimetinib plus chemotherapy, with or without atezolizumab, as first-line treatment for patients with locally advanced or metastatic triple-negative breast cancer (COLET): primary analysis
No full textBackground: Resistance to standard chemotherapy in metastatic triple-negative breast cancer (mTNBC) is associated with upregulation of the mitogen-activated protein kinase (MAPK) pathway. Cobimetinib, an MAPK/extracellular signal-regulated kinase (MEK) inhibitor, may increase sensitivity to taxanes and programmed death-ligand 1 inhibitors. COLET is a three-cohort phase II study evaluating first-line cobimetinib plus chemotherapy, with or without atezolizumab, in patients with locally advanced or mTNBC. Patients and methods: Patients were >= 18 years with locally advanced or mTNBC. Following a safety run-in, patients in cohort I were randomized 1:1 to cobimetinib (60 mg, D3-D23 of each 28-day cycle) or placebo, plus paclitaxel (80 mg/m(2), D1, 8, and 15). Additional patients were randomized (1:1) to cohort II or III to receive cobimetinib plus atezolizumab (840 mg, D1 and D15) and either paclitaxel (cohort II) or nab-paclitaxel [cohort III (100 mg/m(2), D1, D8, and D15)]. Primary endpoints were investigator-assessed progression-free survival (PFS) (cohort I) and confirmed objective response rate (ORR) (cohorts II/III). Safety and tolerability were also assessed. Results: In the expansion stages, median PFS was 5.5 months for cobimetinib/paclitaxel versus 3.8 months for placebo/paclitaxel in cohort I [hazard ratio 0.73; 95% confidence interval (CI) 0.43-1.24; P = 0.25]. In cohort I, ORR was 38.3% (95% CI 24.40-52.20) for cobimetinib/paclitaxel and 20.9% (95% CI 8.77-33.09) for placebo/paclitaxel; ORRs in cohorts II and III were 34.4% (95% CI 18.57-53.19) and 29.0% (95% CI 14.22-48.04), respectively. Diarrhea was the most common grade >= 3 adverse events across all cohorts. Conclusions: Cobimetinib added to paclitaxel did not lead to a statistically significant increase in PFS or ORR, although a nonsignificant trend toward a numerical increase was observed. Cobimetinib plus atezolizumab and a taxane did not appear to increase ORR. This demonstrates the potential activity of a combinatorial MEK inhibitor, chemotherapy, and immunotherapy in this difficult-to-treat population.This work was supported by F. Hoffmann-La Roche Ltd, Basel, Switzerland (no grant numbers apply). Support for third-party writing assistance for this manuscript, furnished by Stephen Salem, BSc, of Health Interactions, was provided by F. Hoffmann-La Roche Ltd.Brufsky, A (corresponding author), Univ Pittsburgh, Dept Med, Div Hematol Oncol, Med Ctr, 300 Halket St,Suite 4628, Pittsburgh, PA 15213 USA.
Loi, S (corresponding author), Peter MacCallum Canc Ctr, Div Clin Med & Res, 305 Grattan St, Melbourne, Vic 3000, Australia.
[email protected]; [email protected]
Screening for biomarkers of liver injury induced by Polygonum multiflorum: a targeted metabolomic study
No full textHeshouwu (HSW), the dry roots of Polygonum multiflorum, a classical traditional Chinese medicine is used as a tonic for a wide range of conditions，particularly those associated with aging. However, it tends to be taken overdose or long term in these years, which has resulted in liver damage reported in many countries. In this study, the indicative roles of nine bile acids (BAs) were evaluated to offer potential biomarkers for HSW induced liver injury. Nine BAs including cholic acid (CA) and chenodeoxycholic acid (CDCA), taurocholic acid (TCA), glycocholic acid (GCA), glycochenodeoxycholic acid (GCDCA), deoxycholic acid (DCA), glycodeoxycholic acid (GDCA), ursodeoxycholic acid (UDCA) and hyodeoxycholic acid (HDCA) in rat bile and serum were detected by a developed LC-MS method after 42 days treatment. Partial least square-discriminate analysis (PLS-DA) was applied to evaluate the indicative roles of the nine BAs, and metabolism of the nine BAs was summarized. Significant change was observed for the concentrations of nine BAs in treatment groups compared with normal control; In the PLS-DA plots of nine BAs in bile, normal control and raw HSW groups were separately clustered and could be clearly distinguished, GDCA was selected as the distinguished components for raw HSW overdose treatment group. In the PLS-DA plots of nine BAs in serum, the normal control and raw HSW overdose treatment group were separately clustered and could be clearly distinguished, and HDCA was selected as the distinguished components for raw HSW overdose treatment group. The results indicated the perturbation of nine BAs was associated with HSW induced liver injury; GDCA in bile, as well as HDCA in serum could be selected as potential biomarkers for HSW induced liver injury; it also laid the foundation for the further search on the mechanisms of liver injury induced by HSW
Breast cancer in limited-resource countries: an overview of the Breast Health Global Initiative 2005 guidelines
No full textBreast cancer is the most common cause of cancer-related death among women worldwide, with case fatality rates highest in low-resource countries. Despite significant scientific advances in its management, most of the world faces resource constraints that limit the capacity to improve early detection, diagnosis, and treatment of the disease. The Breast Health Global Initiative (BHGI) strives to develop evidence-based, economically feasible, and culturally appropriate guidelines that can be used in nations with limited health care resources to improve breast cancer outcomes. Using an evidence-based consensus panel process, four BHGI expert panels addressed the areas of early detection and access to care, diagnosis and pathology, treatment and resource allocation, and health care systems and public policy as they relate to breast health care in limited-resource settings. To update and expand on the BHGI Guidelines published in 2003, the 2005 BHGI panels outlined a stepwise, systematic approach to health care improvement using a tiered system of resource allotment into four levels—basic, limited, enhanced, and maximal—based on the contribution of each resource toward improving clinical outcomes. Early breast cancer detection improves outcome in a cost-effective fashion assuming treatment is available, but requires public education to foster active patient participation in diagnosis and treatment. Clinical breast examination combined with diagnostic breast imaging (ultrasound ± diagnostic mammography) can facilitate cost-effective tissue sampling techniques for cytologic or histologic diagnosis. Breast-conserving treatment with partial mastectomy and radiation therapy requires more health care resources and infrastructure than mastectomy, but can be provided in a thoughtfully designed limited-resource setting. The availability and administration of systemic therapies are critical to improving breast cancer survival. Estrogen receptor testing allows patient selection for hormonal treatments (tamoxifen, oophorectomy). Chemotherapy, which requires some allocation of resources and infrastructure, is needed to treat node-positive, locally advanced breast cancers, which represent the most common clinical presentation of disease in low-resource countries. When chemotherapy is not available, patients with locally advanced, hormone receptor-negative cancers can only receive palliative therapy. Future research is needed to better determine how these guidelines can best be implemented in limited-resource settings. [ABSTRACT FROM AUTHOR
Metabolomics coupled with multivariate data and pathway analysis on potential biomarkers in cholestasis and intervention effect of Paeonia lactiflora Pall.
No full textBackground: The dried root of Paeonia lactiflora Pall. (PLP) is a classical Chinese herbal medicine that has been used to treat hepatic disease for thousands of years. Our previous work suggested that PLP can be used to treat hepatitis with severe cholestasis. This study explored the mechanism by which PLP affects ANIT-induced cholestasis in rats using a metabolomics approach.Methods: The effects of PLP on serum indices (TBIL, DBIL, AST, ALT, ALP and TBA) and the histopathology of the liver were analyzed. Moreover, UHPLC-Q-TOF was performed to identify the possible effect of PLP on metabolites. The pathway analysis was conducted to illustrate the pathways and network by which PLP treats cholestasis. Result: High-dose PLP remarkably down-regulated the serum indices and alleviated histological damage to the liver. Metabolomics analyses showed that the therapeutic effect of high-dose PLP is mainly associated with the regulation of several metabolites, such as glycocholic acid, taurocholic acid, glycochenodeoxycholic acid, L(D)-arginine and L-tryptophan. A pathway analysis showed that the metabolites were related to bile acid secretion and amino acid metabolism. In addition, the significant changes in bile acid transporters also indicated that bile acid metabolism might be involved in the therapeutic effect of PLP on cholestasis. Moreover, a principal component analysis indicated that the metabolites in the high-dose PLP group were closer to those of the control, whereas those of the moderate dose or low-dose PLP group were closer to those of the ANIT group. This finding indicated that metabolites may be responsible for the differences between the effects of low-dose and moderate-dose PLP. Conclusions: The therapeutic effect of high-dose PLP on cholestasis is possibly related to regulation of bile acid secretion and amino acid metabolism. Moreover, these findings may help better understand the mechanisms of disease and provide a potential therapy for cholestasis
Untargeted metabolomics reveals dose-response characteristics for effect of rhubarb in a rat model of cholestasis
No full textCholestasis is a serious manifestation of liver diseases with limited therapies. Rhubarb, a widely used herbal medicine, has been frequently used at a relatively large dose for treating cholestasis. However, whether large doses are optimal and the therapeutic mechanism remain unclear. To explore these questions, the anti-cholestatic effect of five doses of rhubarb (0.21, 0.66, 2.10, 6.60, and 21.0 g/kg) in an alpha-naphthylisothiocyanate (ANIT)-induced rat model of cholestasis was examined by histopathology and serum biochemistry. A dose-dependent anti-cholestatic effect of rhubarb (0.21-6.6 g/kg) was observed, and an overdose of 21.0 g/kg showed a poor effect. LC-MS-based untargeted metabolomics together with pathway analysis were further applied to characterize the metabolic alterations induced by the different rhubarb doses. Altogether, 13 biomarkers were identified. The dose-response curve based on 9 important biomarkers indicated that doses in the 0.42-6.61 g/kg range (EC20-EC80 range, corresponding to 4.00-62.95 g in the clinic) were effective for cholestasis treatment. The pathway analysis showed that bile acid metabolism and excretion, inflammation and amino acid metabolism were altered by rhubarb in a dose-dependent manner and might be involved in the dose-response relationship and therapeutic mechanism of rhubarb for cholestasis treatment
Treatment of metastatic breast cancer: State-of-the-art, subtypes and perspectives
No full textCurrent treatment of metastatic breast cancer (MBC) aims at achieving meaningful clinical responses, improved quality of life, long-term remissions, prolonged survival, and dares to hope for a cure in a small percentage of cases. This article will discuss both consensus and controversies in the management of MBC in the context of the new evolving breast cancer molecular classification. Hormonal therapy remains the mainstay of management of MBC Luminal A and B. Data is emerging on management of ErbB2-positive HR-positive MBC by combining hormonal manipulation and targeted anti-ErbB2 therapy and has recently received regulatory approval in Europe and USA. The optimal use and duration of single agent or combination chemotherapy is discussed. Data and controversies surrounding the use of newer agents such as nab-paclitaxel, ixabepilone, eribulin, and PARP inhibitors as well as trastuzumab is reviewed. Better understanding of pathophysiology has paved the way for the introduction of newer anti-ErbB2 agents such as lapatinib, pertuzumab, T-DM1 and neratinib. Controversies regarding bevacizumab and anti-angiogenesis are discussed. Bisphosphonates have significantly reduced skeletal related events and made significant improvements in the quality of life of patients with MBC. Newer anti-RANK Ligand antibodies show promising results. Significant advances in the understanding of molecular biology of breast cancer have been made and should lead to an improvement in the outcome of MBC. 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