ABC5 International Consensus Conference on Advanced Breast Cancer, Lisbon, 16 November 2019

Michael Untch; Rachel Würstlein; Diana Lüftner; Renate Haidinger; Peter A. Fasching; Doris Augustin; Susanne Briest; Johannes Ettl; Frank Förster; Christian M. Kurbacher; Hans-Joachim Lück; Norbert Marschner; Lothar Müller; Volkmar Müller; Isabel Radke; Eugen Ruckhäberle; Iris Scheffen; Eva Schumacher-Wulf; Moritz Schwoerer; Dieter Steinfeld-Birg; Katja Ziegler-Löhr; Christoph Thomssen; Nadia Harbeck

doi:10.1055/a-1139-9380

Geburtshilfe und Frauenheilkunde, Table of Contents

CC BY-NC-ND 4.0 · Geburtshilfe Frauenheilkd 2020; 80(06): 588-600
DOI: 10.1055/a-1139-9380

GebFra Science

Review/Übersicht

ABC5 International Consensus Conference on Advanced Breast Cancer, Lisbon, 16 November 2019

Commentary by the German panel of experts on the ABC5 voting results^{[
¹
]} Article in several languages: English | deutsch

Michael Untch

¹Klinik für Gynäkologie und Geburtshilfe, Brustzentrum und Gynäkologisch Onkologisches Zentrum, HELIOS Klinikum Berlin Buch, Berlin, Germany

,

Rachel Würstlein

²Brustzentrum und Comprehensive Cancer Center (CCC) München, Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Universität München (LMU), München, Germany

,

Diana Lüftner

³Medizinische Klinik mit Schwerpunkt Hämatologie, Onkologie und Tumorimmunologie, Charité Berlin, Campus Benjamin Franklin, Berlin, Germany

,

Renate Haidinger

⁴Brustkrebs Deutschland e. V.; patient advocate, Germany

,

Peter A. Fasching

⁵Universitätsfrauenklinik Erlangen, Comprehensive Cancer Center (CCC) Erlangen-EMN, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany

,

Doris Augustin

⁶Mammazentrum Ostbayern, DONAUISAR Klinikum Deggendorf, Deggendorf, Germany

,

Susanne Briest

⁷Klinik und Poliklinik für Frauenheilkunde, Universitätsklinikum Leipzig, Leipzig, Germany

,

Johannes Ettl

⁸Frauenklinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Klinikum rechts der Isar, München, Germany

,

Frank Förster

⁹Praxis für Gynäkologie und Geburtshilfe, Gynäkologische Onkologie und Palliativmedizin, Poliklinik gGmbH, Chemnitz, Germany

,

Christian M. Kurbacher

¹⁰Gynäkologie I (Gynäkologische Onkologie), Gynäkologisches Zentrum, Bonn-Friedensplatz, Bonn, Germany

,

Hans-Joachim Lück

¹¹Schwerpunktpraxis für Hämato-Onkologie, Hannover, Germany

,

Norbert Marschner

¹²Gemeinschaftspraxis für interdisziplinäre Onkologie und Hämatologie, Freiburg, Germany

,

Lothar Müller

¹³Onkologische Schwerpunktpraxis Leer-Emden-Papenburg, Leer, Emden, Papenburg, Germany

,

Volkmar Müller

¹⁴Universitätsfrauenklinik Hamburg-Eppendorf, Hamburg, Germany

,

Isabel Radke

¹⁵Brustzentrum, Universitätsklinikum Münster, Münster, Germany

,

Eugen Ruckhäberle

¹⁶Frauenklinik, der Heinrich-Heine-Universität, Düsseldorf, Germany

,

Iris Scheffen

¹⁷Brustzentrum am St. Elisabeth-Krankenhaus GmbH, Köln, Germany

,

Eva Schumacher-Wulf

¹⁸Mamma Mia! Brustkrebs-Magazin, Kronberg, Germany

,

Moritz Schwoerer

¹⁹Frauenklinik, Klinikum Fürstenfeldbruck, Fürstenfeldbruck, Germany

,

Dieter Steinfeld-Birg

²⁰Gynäkologische Onkologie Augsburg, Augsburg, Germany

,

Katja Ziegler-Löhr

²¹Schwerpunktpraxis für gynäkologische Onkologie, Köln, Köln, Germany

,

Christoph Thomssen

²²Universitätsklinik und Poliklinik für Gynäkologie, Martin-Luther-Universität, Halle an der Saale; ABC panel member, ABC scientific committee member, Germany

,

Nadia Harbeck

²³Brustzentrum und Comprehensive Cancer Center (CCC) München, Universität München (LMU), München; ABC panel member, Germany

› Author Affiliations

Abstract

The Advanced Breast Cancer Fifth International Consensus Conference (ABC5) which focuses on the diagnosis and treatment of advanced breast cancer was held in Lisbon on November 14 – 16, 2019. The aim of the conference is to standardize the treatment of advanced breast cancer worldwide using evidence-based data and to ensure that patients with advanced breast disease anywhere in the world are treated appropriately and have access to the latest therapies. This year, the emphasis was on new developments and study results from patients with advanced breast cancer as well as precision medicine. The collaboration with patient advocates from all over the globe is also an important goal of the ABC Conference, which is why the international ABC panel also included a number of patient advocates. We present a commentary on the voting results of the ABC5 panelists in Lisbon by a working group of German breast cancer specialists together with the implications for routine clinical care in Germany. The commentary is based on the recommendations of the Breast Commission of the German Gynecological Oncology Working Group (AGO). This commentary is useful, it includes country-specific features for the ABC consensus.

Key words

ABC5 consensus - advanced breast cancer - precision medicine - 2019 study data

Full Text

References

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