COMMENTARY

Global Alliance Addresses Slow Progress in Advanced Breast Cancer

Kate M. O'Rourke

Disclosures

November 27, 2017

In the past decade, much has changed in the treatment of metastatic breast cancer (MBC), but progress has been slow overall. Recently, Medscape reached out to breast cancer experts to discuss the progress achieved and efforts by the ABC Global Alliance to move forward.

Achievable Goals

In 2016, the Global Status of Metastatic Breast Cancer: A 2005-2015 Decade Report concluded that patients with MBC have had limited improvement.[1] "The median survival for patients with MBC has remained for many decades at 2-3 years after diagnosis," said Fatima Cardoso, MD, Director of the Breast Unit of the Champalimaud Clinical Centre in Lisbon, Portugal, and steering committee chair of the 2016 report. "In the report, the percentage of women alive at 5 years went from 23% to 25%, so really, there was a very small increase in 10 years' time." This slow progress has also been documented in other reports.[2,3]

The reasons for the slow pace include the fact that the early setting of breast cancer is more lucrative for pharmaceutical companies. Almost every breast cancer drug is tested first in the metastatic setting, but when results start looking positive, a drug is usually moved to the early setting for study, said Dr Cardoso. Paclitaxel and trastuzumab (Herceptin®) are two examples of this. The 2016 report also identified other shortcomings, including limited improvement in quality of life of patients with MBC, limited awareness about the extent to which MBC affects a patient's capacity to work, and the absence of legal protection for right to work.

In response to the report, in November 2016, the European School of Oncology established the ABC Global Alliance, a multi-stakeholder platform for those interested in collaborating on common projects relating to advanced breast cancer (ABC) worldwide.

"The idea is to have achievable goals for the next 10 years, not a wish list."

Last month, the ABC Global Alliance released a list of 10 goals (Table). Among the goals are to double the median overall survival for patients with MBC to at least 4 years by 2025, improve the quality of life for patients with MBC, improve the availability of robust epidemiology and outcomes data, increase the availability and access to multidisciplinary care, and strive for all patients with ABC to have financial support for treatment and care.

"The idea is to have achievable goals for the next 10 years, not a wish list. We were not going to say, we would like to find a cure for ABC in 10 years. It would be extremely difficult for that to happen," said Dr Cardoso. "The work of the Alliance is to coordinate all the efforts of all of the different members, so that we can work together to achieve these goals and learn from each other. There are a lot of things that have been tested in some countries that have not proven to be a good way forward. Instead of everyone starting all over, we can learn from each other about what works and what does not work."

Table. 10 Actions for Change From the ABC Global Alliance

  1. Double median overall survival for patients with advanced breast cancer (ABC) to at least 4 years by 2025.

  2. Improve quality of life (QoL) for patients with ABC in clinical practice.

  3. Improve the availability of robust epidemiology and outcomes data on ABC.

  4. Increase availability and access to multidisciplinary care, including palliative, supportive, and psychosocial assistance for patients, families, and caregivers, to ensure that patients are receiving the best treatment experience.

  5. Strive for all patients with ABC to have financial support for treatment, care, and assistance if unable to work.

  6. Offer communication skills training to all healthcare providers (HCPs).

  7. Provide accurate and up-to-date ABC-specific information tools to all patients who want them.

  8. Increase public understanding of ABC.

  9. Improve access to nonclinical supportive services for ABC.

  10. Protect workforce rights for patients with ABC.

The Alliance is in the process of prioritizing the goals now. "We are going to decide what we are going to do for the next 2 years and what type of actions need to be implemented in the different countries," said Dr Cardoso. "The realities are different around the world. There are certain countries where certain measures are more urgent than others. In many countries, this has to do with access to available therapies and available knowledge. In other countries, it will be a bigger investment in research that is dedicated to MBC." She said the Alliance would be delineating actions needed to achieve these goals in roughly three weeks during its first face-to-face meeting, right after the ABC4 Consensus Conference.

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