Locally advanced breast cancer

Treatment guideline implementation with particular attention to low- and middle-income countries

Authors

  • Nagi S. El Saghir MD,

    Corresponding author
    1. Division of Hematology-Oncology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
    • Division of Hematology-Oncology, Department of Internal Medicine, American University of Beirut Medical Center, PO Box 11 0236 Riad El Solh, Beirut, Lebanon
    Search for more papers by this author
    • Fax: (011)961 1 747 144

  • Alexandru Eniu MD,

    1. Department of Breast Tumors, Cancer Institute “Ion Chiricuta” Cluj-Napoca, Romania
    Search for more papers by this author
  • Robert W. Carlson MD,

    1. Stanford Comprehensive Cancer Center, Stanford University, Stanford, California
    Search for more papers by this author
  • Zeba Aziz MD,

    1. Department of Oncology, Allama Iqbal Medical College, Lahore, Pakistan
    Search for more papers by this author
  • Daniel Vorobiof MD,

    1. Medical Oncology, Sandton Oncology Center, Johannesburg, South Africa
    Search for more papers by this author
  • Gabriel N. Hortobagyi MD,

    1. Department of Breast Medical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
    Search for more papers by this author
  • on behalf of the Breast Health Global Initiative Systemic Therapy Focus Group

    Search for more papers by this author
    • Breast Health Global Initiative Systemic Therapy Focus Group members included Zeba Aziz, Jose Bines, Ashwini Budrukkar, Robert Carlson, Eduardo Cazap, Nagi El Saghir, Ahmed Elzawawy, Alexandru Eniu, Gabriel Hortobagyi, Raimund Jakesz, Richard Love, Jose Miquel Reyes, Christy Russell, and Daniel Vorobiof.


  • Complete financial disclosures are presented at the end of this article.

Abstract

The 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. Cancer 2008;113(8 suppl):2315–24. © 2008 American Cancer Society.

Ancillary