Abstract
Current Japanese and American guidelines for the surveillance of patients diagnosed with early stage breast cancer recommend regular follow-up including mammography, history, and physical examination; however, additional routine laboratory and imaging studies are not recommended because there is no evidence of improved clinical outcomes associated with the early detection of distant metastasis. Metastatic breast cancer (MBC) remains a largely incurable disease. The goals of treatment for MBC are to maintain quality of life and prolong survival. However, despite the emergence of new concepts including oligometastases, cancer stem cells, and the development of individualized therapies, clinical management and treatment guidelines remain largely unchanged. The future prospects for personalized management strategies for patients with MBC are described in this review.
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References
Early Breast Cancer Trialists’ Collaborative Group. Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15 years survival: an overview of the randomized trials. Lancet. 2005;365:1687–717.
Kennecke H, Yerushalmi R, Woods R, Cheang MCU, Voduc D, Speers CH, et al. Metastatic behavior of breast cancer subtypes. J Clin Oncol. 2010;28:3271–7.
Norton L, Massague J. Is cancer a disease of self-seeding? Nat Med. 2006;12:875–8.
Paget S. The distribution of secondary growths in cancer of the breast. Cancer Metastasis Rev. 1989;8:98–101.
Liu S, Wicha MS. Targeting breast cancer stem cells. J Clin Oncol. 2010;28:4006–12.
Mansi JL, Gogas H, Bliss JM, Gazet J-C, Berger U, Coombes RC. Outcome of primary-breast-cancer patients with micrometastases: a long-term follow-up study. Lancet. 1999;354:197–202.
Braun S, Vogel FD, Naume B, Janni W, Osborne MP, Coombes RC, et al. A pooled analysis of bone marrow micrometastasis in breast cancer. N Engl J Med. 2005;353:793–802.
Gerber B, Krause A, Muller H, Richter D, Makovitzky J, Herrnring C, et al. Simultaneous immunohistochemical detection of tumor cells in lymph nodes and bone marrow aspirates in breast cancer and its correlation with other prognostic factors. J Clin Oncol. 2001;19:960–71.
Bidard F-C, Vincent-Salomon A, Gomme S, Nos C, Rycke Y, Thiery JP, et al. Disseminated tumor cells of breast cancer patients: a strong prognostic factor for distant and local relapse. Clin Cancer Res. 2008;14:3306–11.
Diel IJ, Kaufmann M, Costa S, Holle R, Minckwitz G, Solomayer EF, et al. Micrometastatic breast cancer cells in bone marrow at primary surgery: prognostic value in comparison with nodal status. J Natl Cancer Inst. 1996;88:1652–64.
Wiedswang G, Borgen E, Karesen R, Kvalheim G, Neslamnd JM, Qvist H, et al. Detection of isolated tumor cells in bone marrow is an independent prognostic factor in breast cancer. J Clin Oncol. 2003;21:3469–78.
Xenidis N, Perraki M, Kafousi M, Apostolaki S, Bolonaki I, Stathopoulou A, et al. Predictive and prognostic value of peripheral blood cytokeratin-19 mRNA-positive cells detected by real-time polymerase chain reaction in node-negative breast cancer patients. J Clin Oncol. 2006;24:3756–62.
Wiedswang G, Borgen E, Schirmer C, Karesen R, Kvalheim G, Nesland JM, et al. Comparison of the clinical significance of occult tumor cells in blood and bone marrow in breast cancer. Int J Cancer. 2006;118:2013–9.
Kennecke HF, McArthur H, Olivotto IA, Speers C, Bajdik C, Chia SK, et al. Risk of early recurrence among postmenopausal women with estrogen receptor-positive early breast cancer treated with adjuvant tamoxifen. Cancer. 2008;112:1437–44.
Saphner T, Tormey DC, Gray R. Annual hazard rates of recurrence for breast cancer after primary therapy. J Clin Oncol. 1996;14:2738–46.
Kennecke HF, Olivotto IA, Speers C, Norris B, Chia SK, Bryce C, et al. Late risk of relapse and mortality among postmenopausal women with estrogen responsive early breast cancer after 5 years of tamoxifen. Ann Oncol. 2007;18:45–51.
Pantel K, Alix-Panabieres C, Riethdorf S. Cancer micrometastases. Nat Rev Clin Oncol. 2009;6:339–51.
The Japanese clinical guideline for breast cancer based on scientific evidences 1: medical treatment. 2010;57–59 (in Japanese).
Rahman ZU, Frye DK, Smith TL, Asmar L, Theriault RL, Buzdar AU, et al. Results and long term follow-up for 1581 patients with metastatic breast carcinoma treated with standard dose doxorubicin-containing chemotherapy. Cancer. 1999;85:104–11.
Toi M, Nakamura S, Kuroi K, Iwata H, Ohno S, Masuda N, et al. Phase II study of preoperative sequential FEC and docetaxel predicts of pathological response and disease free survival. Breast Cancer Res Treat. 2008;110:531–9.
Pagani O, Senkus E, Wood W, Colleoni M, Cufer T, Kyriakides S, et al. International guidelines for management of metastatic breast cancer: can metastatic breast cancer be cured? J Natl Cancer Inst. 2010;102:456–63.
Hanrahan EO, Broglio KR, Buzdar AU, Theriaults RL, Valero V, Cristofanilli M, et al. Combined-modality treatment for isolated recurrences of breast carcinoma. Update on 30 years of experience at the University of Texas M.D. Anderson Cancer Center and assessment of prognostic factors. Cancer. 2005;104:1158–71.
Khatcheressian JL, Wolff AC, Smith TJ, Grunfeld E, Muss HB, Vogel VG, et al. American society of clinical oncology 2006 update of the breast cancer follow-up and management guidelines in the adjuvant setting. J Clin Oncol. 2006;24:5091–7.
The GIVIO Investigators. Impact of follow-up testing on survival and health-related quality of life in breast cancer patients. A multicenter randomized controlled trial. JAMA. 1994;271:1587–92.
Rosselli Del Turco M, Palli D, Cariddi A, Ciatto S, Pacini P, Distante V. Intensive diagnostic follow-up after treatment of primary breast cancer. A randomized trial. National Research Council project on breast cancer follow-up. JAMA. 1994;271:1593–7.
Palli D, Russo A, Saieva C, Ciatto S, Rosselli Del Turco M, Distante V, et al. Intensive vs clinical follow-up after treatment of primary breast cancer: 10-year update of randomized trial. National Research Council project on breast cancer follow-up. JAMA 1999;281:1586.
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Iwata, H. Future treatment strategies for metastatic breast cancer: curable or incurable?. Breast Cancer 19, 200–205 (2012). https://doi.org/10.1007/s12282-011-0267-4
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DOI: https://doi.org/10.1007/s12282-011-0267-4