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ABC1 - Advanced Breast Cancer First International Consensus Conference
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Can Outcomes for Metastatic Breast Cancer be Changed? ----- A Report by Shirley Mertz
Latest update: 3/2012 Click HERE to read the ABC1 practice guidelines agreed upon, as published in The Breast medical journal.
11/2011: As a research advocate and metastatic breast cancer patient, I have attended many breast cancer conferences in the United States where I seek updates and information about metastatic disease. I often wished I had the power to corral into one large auditorium the oncologists, radiologists and pathologists who treat metastatic breast cancer patients and invite these clinicians to share their best practices and strategies annually so that patients could have better outcomes. My wish was realized this past November 3 through 5, not in the United States, but in Lisbon, Portugal where I attended the First Advanced Breast Cancer International Consensus Conference (ABC1).
There, a Portuguese oncologist, Fatima Cardoso, who co-chaired and hosted the event, stated courageously that metastatic disease has been neglected for treatment and management guidelines in favor of early stages because of its difficulty and complexity. She said that women faced with metastatic illness deserve much more positive, evidence-based approaches and support systems that lessen the frequent isolation felt by people with an incurable condition.
The passionate Dr. Cardoso said, "It is metastatic disease that kills patients so we will never cure breast cancer unless we focus much more on its advanced stage. Already, a small subset of those with metastatic cancer shows promise for a cure, if we identify and manage them correctly. If we could transform the disease into a chronic condition for the majority of patients, it would be a major step forward. We have to convince investigators and the industry that it is worthwhile to invest in high quality clinical and translational research that could lead to major gains, as we have done in early-stage disease."
For two intense days, over 800 clinicians, scientists, patients and advocates heard presentations about basic research, imaging, pathology, the management of various phenotypes of metastatic breast cancer (hormone positive, HER2-positive and triple negative breast cancers), and ways to address treatment resistance.
On the third day, thirty-three Consensus Panelists reviewed, one by one, fifty statements in draft form that could guide best clinical practices for metastatic disease. Each statement was discussed, and then a vote was called to support or reject the statement's inclusion in an official guidelines document. There was near unanimous agreement on some statements, but there were areas of strong disagreement on others. Often, these disagreements concerned issues that lack high-level evidence, especially concerning treatment after first line therapy. The many differences aired in the panel discussions about statements relating to drug treatment stem from another obstacle to progress in the metastatic setting. In drug development, industry and the cooperative research groups tend to see the metastatic research setting primarily as a bridge to reach early stage patients. This often leaves important management questions for metastatic breast cancer patients unanswered.
The ABC1 Conference leaders, Dr. Cardoso, Dr. Eric Winer of Dana-Farber Cancer Institute (Boston), and Dr. Larry Norton of Memorial Sloan-Kettering Cancer Center (New York) cited the need for funding for research to get high-level evidence about metastatic treatments and to further knowledge about metastatic progression in breast cancer.
After editing and final agreement on the actions of the Consensus Panel, a Guidelines document will be presented in the beginning of 2012 in The Breast, an international, multidisciplinary journal for clinicians, which focuses on translational and clinical research.
The Metastatic Breast Cancer Network will update all its members on the specific guidelines that emerge early in 2012 from the ABC1 Conference. Metastatic patients need to educate themselves about the guidelines once they are published. We need to spread the word about the guidelines with our clinicians and other patients.
We also must demand that the amount of resources (funding) dedicated to metastatic breast cancer research for metastatic patients be increased. Finally, while there is much talk about providing personalized treatment in the clinic to patients with early stage disease, now, more than ever, clinicians must apply the same approach in the metastatic setting so that outcomes can be realized, one patient at a time.
"If we could transform the disease into a chronic condition for the majority of patients, it would be a major step forward."
- Dr. Fatima Cardoso, Lisbon
"Survival of people with advanced breast cancer is increasing, but progress is painfully slow. Despite many other meetings about breast cancer, management of metastatic disease has suffered from a lack of strong international collaboration in clinical and translational research that could lead to faster advances and evidence-based care standards. As a result, patients and carers often feel lost in a maze of many different opinions and scattered guideline efforts."
- Dr. Eric Winer, Dana Farber Institute
"ABC1 is a crucial first step and patients and advocates are watching and grateful that our time has finally come."
- Musa Mayer, advocate
"We have to convince investigators and the industry that it is worthwhile to invest in high quality clinical and translational research that could lead to major gains, as we have done in early-stage disease."
- Dr. Fatima Cardoso, Lisbon
