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Locally advanced breast cancer†
Treatment guideline implementation with particular attention to low- and middle-income countries
Article first published online: 3 OCT 2008
Copyright © 2008 American Cancer Society
Supplement: Guidelines for International Breast Health and Cancer Control–Implementation
Volume 113, Issue Supplement 8, pages 2315–2324, 15 October 2008
How to Cite
El Saghir, N. S., Eniu, A., Carlson, R. W., Aziz, Z., Vorobiof, D., Hortobagyi, G. N. and on behalf of the Breast Health Global Initiative Systemic Therapy Focus Group (2008), Locally advanced breast cancer. Cancer, 113: 2315–2324. doi: 10.1002/cncr.23836
Complete financial disclosures are presented at the end of this article.
- Issue published online: 3 OCT 2008
- Article first published online: 3 OCT 2008
- Manuscript Accepted: 24 JUN 2008
- Manuscript Received: 10 JUN 2008
- The Breast Health Global Initiative Global Summit
- Bristol-Myers Squibb Company
- Ethicon Endo Surgery, Inc.
- GE Healthcare
- F. Hoffmann-La Roche AG
- Novartis Oncology
- Pfizer Inc.
- primary systemic therapy;
- neoadjuvant therapy;
- locally advanced breast cancer;
- low-income countries
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.