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Handbook of Metastatic Breast Cancer

2nd Edition, November 14, 2011

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Active, Most Current

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ISBN: 978-1-84184-812-9
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Product Details:

  • Revision: 2nd Edition, November 14, 2011
  • Published Date: November 14, 2011
  • Status: Active, Most Current
  • Document Language: English
  • Published By: CRC Press (CRC)
  • Page Count: 312
  • ANSI Approved: No
  • DoD Adopted: No

Description / Abstract:


Despite signifi cant advances in the diagnosis and treatment of breast cancer, approximately one-third of patients still develop and subsequently die from metastatic breast disease. Globally, half a million deaths each year are attributable to metastatic breast cancer and the median survival time from the diagnosis of secondary disease is approximately 3 years. The range is very wide however, with some patients having more indolent disease that they can live with for 10–15 years, while for others with widespread metastatic disease, the prognosis may only be a matter of months from the time of diagnosis. While this may represent the extent and distribution of metastatic disease, in part it refl ects the biological diversity of breast cancer, with some women having disease that exhibits extreme sensitivity to hormonal treatments, whereas others with so-called triple-negative breast cancer may display relative resistance to all systemic therapies. In recent years, the increasing recognition that different molecular subtypes of breast cancer exist has substantially changed not only the way we classify and treat the disease, but also the impact that certain novel therapeutics in the metastatic setting can have on specifi c types of breast cancer.

In a rapidly evolving fi eld in modern medicine where cancer genetics, molecular profi ling, and targeted therapeutics have all had a huge impact over the last 5 years, it is timely to update the fi rst edition of this "Handbook of Metastatic Breast Cancer" that was fi rst published in 2006. Although the principles of treating the disease remain unchanged, there have been suffi cient advances in several aspects of clinical management to merit a second edition that includes the most up-to-date information and results of clinical trials, and discusses the impact of these developments on the management of patients with metastatic breast cancer. There is a new chapter that discusses the molecular taxonomy of breast cancer, focusing on the relevance of gene expression signatures and predictive and prognostic biomarkers in the treatment of metastatic breast cancer. In addition, there are three new chapters on specialist systemic treatment options, including targeting HER2+ and issues relating to trastuzumab-resistant metastatic breast cancer, management of triple-negative sporadic and BRCA germline metastatic disease, and the role of angiogenesis inhibitors in the treatment of advanced breast cancer. We have provided signifi cant updates to the existing chapters that discuss various systemic treatments for breast cancer, including endocrine therapy, chemotherapy, targeted therapies, and bisphosphonates. In addition we have updated the information on diagnostic imaging and tumour assessment, including the role of positron emission tomography and other functional imaging modalities.

The principal aim of treatment for secondary breast cancer remains to increase the duration of symptom-free survivorship and limit treatment-related toxicity, and thereby ensure the maximum quality of life for most of the patients. It is acknowledged that metastatic breast cancer can affect many parts of the body and this requires a wide range of treatments to control local symptoms. Therefore, it is strongly recommended that these patients are now managed by a specialist, multidisciplinary secondary breast cancer team which works closely with palliative care specialists and associated medical specialities as required. These aspects of multimodality management should underpin modern day services for women with secondary breast cancer, and we have updated the chapters from allied professionals that discuss local treatment options for neurological, thoracic, orthopaedic, and hepatic complications in advanced secondary breast cancer.

The high prevalence of the disease, together with the relatively long natural history for many patients, means that in the United Kingdom approximately 100,000 women are living with a diagnosis of secondary breast cancer each year. However, for these women the true impact of living with an incurable condition and coping with an uncertain future is something that often goes unrecognised by health-care professionals. The diagnosis of metastatic breast cancer is always a devastating event for any patient who has received previous therapy for early breast cancer that was given with the hope and expectation of cure. Therefore, when secondary disease returns it is associated with the realisation that "cure" is no longer possible. The information needs of patients are now very complex, made more challenging and sometimes confusing by the vast volume of information available to patients via the Internet. This means that specialist information and support services for patients and their families are vitally important, and in many centres this is now provided by clinical nurse specialists in secondary breast cancer. The role of these support services is discussed in a new chapter.

While at present metastatic breast cancer cannot be cured, modern systemic and loco-regional treatment can be very effective in maximising the duration of a patient's quality time without disease-related symptoms, which if signifi cant in itself will often manifest as prolonged survival. With the introduction of more effective therapies over the last two decades, there has been a substantial improvement in clinical outcomes for women with metastatic breast cancer compared to treatment therapies available 30 years ago. Indeed many patients can now expect to live with metastatic secondary breast cancer for several years. However, many challenges continue to remain in the development of novel therapies proving that a given intervention on its own impacts on overall survival; this is because with so many effective therapies to offer patients with advanced disease, randomised trials against no therapy or "best supportive care" are impossible and indeed unethical to conduct in this disease. Furthermore, because breast cancer in general is relatively sensitive to the various drugand radiation-based therapies that are available, with multiple lines of treatment often being used during the course of a patient's illness, subsequent therapies given in sequence will undoubtedly have a major impact on patient outcome. This makes the likelihood of a novel therapy in the fi rst-line setting having a signifi cant impact on overall survival almost impossible to demonstrate. Because of this, "progressionfree survival" has become in some instances a recognised primary endpoint that is used to demonstrate to regulatory authorities the clinical utility of any given novel therapeutic. For most patients and their health-care professionals, an effective therapy that controls disease without toxicities, from which life expectancy may be prolonged, remains the most important objective in the management of the disease.

As outcomes for women with secondary breast cancer continue to improve, there are now genuine grounds for optimism, despite the sense of uncertainty and loss of control that many women inevitably feel once diagnosed. During the past two decades there have been signifi cant advances in the diagnosis and treatment of early breast cancer, refl ected by the signifi cant improvement in mortality from the disease observed both in the United States and Europe since the early 1990s ( 1 ). The United Kingdom has witnessed perhaps the largest single improvement in survival rates form breast cancer, with a 40% reduction in mortality since 1990 ( 2 ). Reasons for this progress are multifactorial and have been attributed to the possible impact of screening and detection of earlier-stage disease, better multidisciplinary management of breast cancer by dedicated specialists, together with a more widespread use of systemic adjuvant therapies including combination chemotherapy and hormonal treatment. Furthermore, the introduction of novel targeted therapies, in particular biological therapies such as trastuzumab for HER2-positive disease, has altered the natural history of advanced breast cancer, with an unprecedented impact on survival from such treatments. As such, it is likely that many patients will now live considerably longer with their secondary breast cancer under control, although cure in this setting still remains an elusive goal.

We hope that the updated second edition of this handbook will be a useful source of information for all health-care professionals involved in the management of patients with metastatic breast cancer. Sharing knowledge helps improve practice, which ultimately benefi ts women affl icted by this disease.