ABC5 – Internationale Konsensuskonferenz zum fortgeschrittenen Mammakarzinom, Lissabon, 16.11.2019

Zusammenfassung

Vom 14. bis 16. November 2019 fand in Lissabon die fünfte internationale Konsensuskonferenz ABC5 (Advanced Breast Cancer Fifth Consensus) zu Diagnostik und Behandlung des fortgeschrittenen Mammakarzinoms statt. Ziel ist es, die Behandlung der Patientinnen mit fortgeschrittenem Mammakarzinom weltweit auf evidenzbasierter Grundlage zu standardisieren und sicherzustellen, dass Patientinnen überall auf der Welt adäquat behandelt werden und Zugang zu neuen Therapien erhalten. Ein inhaltlicher Schwerpunkt lag dieses Jahr auf neuen Entwicklungen und Studienergebnissen beim fortgeschrittenen Mammakarzinom sowie der Präzisionsmedizin. Zudem ist die Zusammenarbeit mit den Patientenvertreterinnen aus aller Welt ein wichtiges Anliegen der ABC-Konferenz, weshalb in dem international zusammengesetzten ABC-Panel auch Patientenvertreterinnen sind. Im vorliegenden Manuskript werden die Abstimmungsergebnisse der ABC5-Panelisten vor Ort durch eine Arbeitsgruppe deutscher Brustkrebsexperten für den Therapiealltag in Deutschland kommentiert. Der Kommentierung liegen die Empfehlungen der Arbeitsgemeinschaft gynäkologische Onkologie (AGO), Kommission „Mamma“ zugrunde. Sie erscheint sinnvoll, da in den ABC-Konsensus auch länderspezifische Besonderheiten einfließen.

Schlüsselwörter

ABC5-Konsensus - fortgeschrittenes Mammakarzinom - Präzisionsmedizin - Studiendaten 2019

¹ Die Stellungnahme der deutschen Expertengruppe basiert auf den Abstimmungsergebnissen der ABC5-Panelisten vor Ort in Lissabon. Das vorliegende Manuskript ist ein Meinungsbild aus der Sicht deutscher Brustkrebs-Experten. Der offizielle ABC5-Konsensus wird an anderer Stelle unter der Autorenschaft der ABC5-Panelisten publiziert.

Publication History

Received: 12 March 2020

Accepted: 16 March 2020

Article published online:
17 June 2020

• References/Literatur

• 1 AGO State-of-the-Art Empfehlungen Diagnose und Therapie des frühen und fortgeschrittenen Mammakarzinoms. Update. 2020 Online (last access: 04.03.2020): www.ago-online.de
• 2 Cardoso F, Senkus E, Costa A. et al. ESO-ESMO 4th international consensus guidelines for advanced breast cancer (ABC 4). Ann Oncol 2018; 29: 1634-1657
• 3 Harbeck N, Lüftner D, Marschner N. et al. ABC4 Consensus: Assessment by a German Group of Experts. Breast Care (Basel) 2018; 13: 48-58
• 4 Cardoso F, Costa A, Norton L. et al. 1st International consensus guidelines for advanced breast cancer (ABC 1). Breast 2012; 21: 242-252 doi:10.1016/j.breast.2012.03.003
• 5 Cardoso F, Costa A, Norton L. et al. ESO-ESMO 2nd international consensus guidelines for advanced breast cancer (ABC2). Breast 2014; 23: 489-502
• 6 Cardoso F, Costa A, Senkus E. et al. ESO-ESMO 3rd international consensus guidelines for advanced breast cancer (ABC 3). Breast 2017; 31: 244-259
• 7 Online (last access: 30.11.2019): http://www.esmo.org/Guidelines/ESMO-Guidelines-Methodology
• 8 Stockler MR, Harvey VJ, Francis PA. et al. Capecitabine Versus Classical Cyclophosphamide, Methotrexate and Fluorouracil As First-Line Chemotherapy for Advanced Breast Cancer. J Clin Oncol 2011; 29: 4498-4504
• 9 Cazzaniga ME, Biganzoli L, Cortesi L. et al. Metronomic Chemotherapy in Advanced Breast Cancer Study Group. Treating advanced breast cancer with metronomic chemotherapy: what is known, what is new and what is the future?. Onco Targets Ther 2019; 12: 2989-2997
• 10 Cazzaniga ME, Pinotti G, Montagna E. et al. VICTOR Study Group. Metronomic chemotherapy for advanced breast cancer patients in the real world practice: Final results of the VICTOR-6 study. Breast 2019; 48: 7-16
• 11 De Iuliis F, Salerno G, Taglieri L. et al. On and off metronomic oral vinorelbine in elderly women with advanced breast cancer. Tumori 2015; 101: 30-35
• 12 Fedele P, Marino A, Orlando L. et al. Efficacy and safety of low-dose metronomic chemotherapy with capecitabine in heavily pretreated patients with metastatic breast cancer. Eur J Cancer 2012; 48: 24-29
• 13 Krajnak S, Battista M, Brenner W. et al. Explorative Analysis of Low-Dose Metronomic Chemotherapy with Cyclophosphamide and Methotrexate in a Cohort of Metastatic Breast Cancer Patients. Breast Care (Basel) 2018; 13: 272-276
• 14 Langkjer ST, Kenholm J, Jensen JD. et al. The NAME trial: a direct comparison of classical oral Navelbine versus Metronomic Navelbine in metastatic breast cancer. Future Oncol 2019; 15: 2561-2569
• 15 Maur M, Omarini C, Piacentini F. et al. Metronomic Capecitabine Effectively Blocks Leptomeningeal Carcinomatosis From Breast Cancer: A Case Report and Literature Review. Am J Case Rep 2017; 18: 208-211
• 16 Montagna E, Bagnardi V, Cancello G. et al. Metronomic Chemotherapy for First-Line Treatment of Metastatic Triple-Negative Breast Cancer: A Phase II Trial. Breast Care (Basel) 2018; 13: 177-181
• 17 Masci G, Losurdo A, Gandini C. et al. Low-dose “metronomic chemotherapy” with oral cyclophosphamide and methotrexate in metastatic breast cancer: a case report of extraordinarily prolonged clinical benefit. Ecancermedicalscience 2012; 6: 275
• 18 Gray R, Bhattacharya S, Bowden C. et al. Independent Review of E2100: A Phase III Trial of Bevacizumab Plus Paclitaxel Versus Paclitaxel in Women With Metastatic Breast Cancer. J Clin Oncol 2009; 27: 4966-4972
• 19 Miller K, Wang M, Gralow J. et al. Paclitaxel plus Bevacizumab versus Paclitaxel Alone for Metastatic Breast Cancer. N Engl J Med 2007; 357: 2666-2676
• 20 Robert NJ, Diéras V, Glaspy J. et al. RIBBON-1: Randomized, Double-Blind, Placebo-Controlled, Phase III Trial of Chemotherapy With or Without Bevacizumab for First-Line Treatment of Human Epidermal Growth Factor Receptor 2-negative, Locally Recurrent or Metastatic Breast Cancer. J Clin Oncol 2011; 29: 1252-1260
• 21 Im SA, Lu Y-S, Bardia AB. et al. Overall Survival with Ribociclib plus Endocrine Therapy in Breast Cancer. N Engl J Med 2019; 381: 307-316
• 22 Slamon D, Neven P, Chia S. et al. Overall survival results of the Phase III MONALEESA-3 trial of postmenopausal patients with hormone receptor-positive human-epidermal growth factor-2-negative advanced breast cancer treated with fulvestrant plus/minus ribociclib. Ann Oncol 2019; 30 (Suppl. 05) v851-v934
• 23 Online (last access: 30.11.2019): http://www.esmo.org/guidlines/esmo-mcbs
• 24 Cherny NI, Sullivan R, Dafni U. et al. A standardised, generic, validated approach to stratify the magnitude of clinical benefit that can be anticipated from anti-cancer therapies: the European Society for Medical Oncology Magnitude of Clinical Benefit Scale. Ann Oncol 2015; 26: 1547-1573
• 25 Cherny NI, Dafni U, Bogaerts J. et al. ESMO Magnitude of Clinical Benefit Scale version 1.1. Ann Oncol 2017; 28: 2340-2366
• 26 Hartkopf AD, Huober J, Volz B. et al. Treatment landscape of advanced breast cancer patients with hormone receptor positive HER2 negative tumors – Data from the German PRAEGNANT breast cancer registry. Breast 2018; 37: 42-51
• 27 Endocrine Therapy Plus CDK4/6 in First or Second Line for Hormone (SONIA) Receptor Positive Advanced Breast Cancer. Online (last access: 02.05.2020): https://clinicaltrials.gov/ct2/show/study/NCT03425838
• 28 André F, Ciruelos E, Rubovszky G. et al. Alpelisib for PIK3CA-mutated, hormone receptor-positive advanced breast cancer. N Engl J Med 2019; 380: 1929-1940
• 29 Park YH, Kim TY, Kim GM. et al. A randomized phase II study of palbociclib plus exemestane with GNRH agonist versus capecitabine in premenopausal women with hormone receptor-positive metastatic breast cancer (KCSG-BR 15–10, NCT02592746). J Clin Oncol 2019; 37 (Suppl.) Abstr.. 1007
• 30 Martín M, Zielinski C, Ruíz-Borrego M. et al. Results from PEARL study (GEICAM/2013-02_CECOG/BC.1.3.006): A phase 3 trial of Palbociclib (PAL) in combination with endocrine therapy (ET) versus Capecitabine (CAPE) in hormonal receptor (HR)-positive/human epidermal growth factor receptor (HER) 2-negative metastatic breast cancer (MBC) patients (pts) whose disease progressed on aromatase inhibitors (AIs). San Antonio Breast Cancer Symposium 2019; GS2-07.
• 31 Mehta RS, Barlow WE, Albain KS. et al. Overall Survival with Fulvestrant plus Anastrozole in Metastatic Breast Cancer. N Engl J Med 2019; 380: 1226-1234
• 32 Bergh J, Jönsson PE, Lidbrink EK. et al. FACT: an open-label randomized phase III study of fulvestrant and anastrozole in combination compared with anastrozole alone as first-line therapy for patients with receptor-positive postmenopausal breast cancer. J Clin Oncol 2012; 30: 1919-1925
• 33 Johnston SR, Kilburn LS, Ellis P. et al. SoFEA investigators. Fulvestrant plus anastrozole or placebo versus exemestane alone after progression on non-steroidal aromatase inhibitors in postmenopausal patients with hormone-receptor-positive locally advanced or metastatic breast cancer (SoFEA): a composite, multicentre, phase 3 randomised trial. Lancet Oncol 2013; 14: 989-998
• 34 Saura C, Oliveira M, Feng YH. Neratinib + capecitabine vs. lapatinib + capecitabine in patients with HER2+ metastatic breast cancer previously treated with ≥ 2 HER2-directed regimens: Findings from the multinational, randomized, phase III NALA trial. JCO ASCO Ann Meeting 2019; #1002.
• 35 Pivot X, Manikhas A, Zurawski B. et al. CEREBEL (EGF111438): A Phase III, Randomized, Open-Label Study of Lapatinib Plus Capecitabine Versus Trastuzumab Plus Capecitabine in Patients With Human Epidermal Growth Factor Receptor 2-Positive Metastatic Breast Cancer. J Clin Oncol 2015; 33: 1564-1573
• 36 Schmid P, Adams S, Rugo H. et al. Atezolizumab and nab-Paclitaxel in Advanced Triple-Negative Breast Cancer. N Engl J Med 2019; 379: 2108-2121
• 37 Cortes J, Lipatov O, Im S. et al. KEYNOTE-119: Phase 3 study of pembrolizumab versus single-agent chemotherapy for metastatic triple-negative breast cancer. Ann Oncol 2019; 30 (Suppl. 05) v851-v934
• 38 Online (last access: 15.12.2019): http://www.gbg.de/de/studien/brainmet.php
• 39 Robson M, Im SA, Senkus E. et al. Olaparib for Metastatic Breast Cancer in Patients with a Germline BRCA Mutation. N Engl J Med 2017; 377: 523-533
• 40 Robson ME, Tung N, Conte P. et al. OlympiAD final overall survival and tolerability results: Olaparib versus chemotherapy treatment of physicianʼs choice in patients with a germline BRCA mutation and HER2-negative metastatic breast cancer. Ann Oncol 2019; 30: 558-566
• 41 Litton JK, Rugo HS, Ettl J. et al. Talazoparib in Patients with Advanced Breast Cancer and a Germline BRCA Mutation. N Engl J Med 2018; 379: 753-763
• 42 Lux M, Lewis K, Rider A. et al. BRCA1/2 Testing in HER2- Advanced Breast Cancer (ABC): Results from the European Component of a Multi-Country Real World Study. Ann Oncol 2019; 30 (Suppl. 05) v99-v103 doi:10.1093/annonc/mdz241 .(Poster ESMO 2019)
• 43 Dieras VC, Han HS, Kaufman B. et al. Phase 3 study of veliparib with carboplatin and paclitaxel in HER2-negative advanced/metastatic gBRCA-associated breast cancer. Ann Oncol 2019; 30 (Suppl. 05) v851-v934
• 44 ESMO Clinical Practice Guidelines: Supportive and Palliative Care. Online (last access: 30.11.2019): https://www.esmo.org/guidelines/Supportive-and-Palliative-Care
• 45 Hortobagyi GN, Van Poznak C, Harker WG. et al. Continued Treatment Effect of Zoledronic Acid Dosing Every 12 vs. 4 Weeks in Women With Breast Cancer Metastatic to Bone: The OPTIMIZE-2 Randomized Clinical Trial. JAMA Oncol 2017; 3: 906-912
• 46 Awan AA, Hutton B, Hilton J. et al. De-escalation of bone-modifying agents in patients with bone metastases from breast cancer: a systematic review and meta-analysis. Breast Cancer Res Treat 2019; 176: 507-517
• 47 Online (last access: 30.11.2019): http://www.awmf.org; Additionally: S3 Guideline “Early Detection, Diagnostics, Therapy and Follow-up Care in Breast Cancer.” Long Version 4.0. – December 2017. AWMF Registry No. 032–045OL. Online (last access: 30.11.2019): www.leitlinienprogramm-onkologie.de
• 48 Expanded S3 Guideline on palliative care for patients with incurable cancer. Long Version 2.0 – August 2019. AWMF Registry number: 128/001-OL. Online (last access: 20.01.2020): https://www.dgpalliativmedizin.de/neuigkeiten/august-2019-erweiterte-s3-leitlinie-palliativmedizin.html
• 49 Dykewicz CA. Summary of the guidelines for preventing opportunistic infections among hematopoietic stem cell transplant recipients. Clin Infect Dis 2001; 33: 139-144