Metastatic breast cancer
Resumo
Definição
História e exame físico
Principais fatores diagnósticos
- bone pain
- pleural effusion
- palpable mass after treatment of the primary tumor
Outros fatores diagnósticos
- shortness of breath
- cough (nonproductive)
- anorexia
- weight loss
- neurologic symptoms (e.g., neuralgic pain, weakness, headaches, seizures)
Fatores de risco
- female sex
- age >50 years
- family history of breast, ovarian, pancreatic, and/or prostate cancer
- breast cancer susceptibility genes (BRCA1, BRCA2, CDH1, PALB2, PTEN, STK11, and TP53)
- tumor >5 cm in diameter
- high number of positive axillary lymph nodes (e.g., >10)
- lymphovascular invasion
- high-risk 70-gene signature
- high-risk 21-gene signature
- high-risk PAM50 gene signature
- Lynch syndrome (hereditary nonpolyposis colorectal cancer)
- CHEK2 mutations
- ATM mutations
- minimal residual disease (MRD)
- bone metastasis and lung metastasis gene signatures
Investigações diagnósticas
Primeiras investigações a serem solicitadas
- CBC
- LFTs
- calcium
- CT (of chest and abdomen)
- bone scan (scintigraphy)
Investigações a serem consideradas
- MRI (focused on area of concern, e.g., brain, spinal cord, bone)
- FDG-PET/CT scan
- biopsy of metastatic lesion
- germline testing for high-penetrance breast cancer susceptibility genes
- additional biomarker testing
- echocardiogram
- multigated acquisition (MUGA) scan
- pleural cytology
Algoritmo de tratamento
hormone receptor-positive, HER2-negative, without visceral crisis: postmenopausal
hormone receptor-positive, HER2-negative, without visceral crisis: premenopausal
hormone receptor-positive, HER2-positive, without visceral crisis: postmenopausal
hormone receptor-positive, HER2-positive, without visceral crisis: premenopausal
hormone receptor-negative, HER2-positive, without visceral crisis
PD-L1-negative, triple-negative (hormone receptor-negative, HER2-negative), without visceral crisis
PD-L1-positive, triple-negative (hormone receptor-negative, HER2-negative), without visceral crisis
hormone receptor-positive or negative, HER2-negative, with visceral crisis
hormone receptor-positive or negative, HER2-positive, with visceral crisis
Colaboradores
Autores
Edward Sauter, MD, PhD
Medical and Program Officer
Division of Cancer Prevention
National Cancer Institute
Rockville
MD
Declarações
ES declares that he has no competing interests.
Wajeeha Razaq, MD
Breast Cancer Site Chair
University Oklahoma School of Medicine
Oklahoma City
OK
Divulgaciones
WR declares that she has no competing interests.
Agradecimientos
Dr Edward Sauter and Dr Wajeeha Razaq would like to gratefully acknowledge Dr Puja Nistala, Dr Donald Doll, Dr Carl E. Freter and Dr Michael Perry, previous contributors to this topic.
Divulgaciones
PN, DD, CEF and MP declare that they have no competing interests.
Revisores por pares
Alan Neville, MD
Professor
Assistant Dean
Undergraduate Program
McMaster University
Hamilton
Ontario
Canada
Divulgaciones
AN declares that he has no competing interests.
Gianfilippo Bertelli, MD, PhD, FRCP (Edin)
Consultant
Honorary Senior Lecturer in Medical Oncology
South West Wales Cancer Centre
Swansea
UK
Divulgaciones
GB has received honoraria for participation in advisory boards (AstraZeneca, Novartis, Pfizer, Roche, GSK, Cephalon, Amgen, Sanofi, Aventis), speaker's fees (AstraZeneca, Novartis, Sanofi, Aventis), and hospitality at conferences (AstraZeneca, Novartis, Pfizer, Roche, Aventis).
Christos Vaklavas, MD
Assistant Professor
Division of Hematology/Oncology
Department of Medicine
University of Alabama at Birmingham
Birmingham
AL
Divulgaciones
CV declares that University of Alabama at Birmingham has received research support from Pfizer, F. Hoffmann-La Roche, and Incyte.
Agradecimiento de los revisores por pares
Los temas de BMJ Best Practice se actualizan de forma continua de acuerdo con los desarrollos en la evidencia y en las guías. Los revisores por pares listados aquí han revisado el contenido al menos una vez durante la historia del tema.
Divulgaciones
Las afiliaciones y divulgaciones de los revisores por pares se refieren al momento de la revisión.
Referencias
Artículos principales
Gennari A, André F, Barrios CH, et al. ESMO clinical practice guideline for the diagnosis, staging and treatment of patients with metastatic breast cancer. Ann Oncol. 2021 Dec;32(12):1475-95.Texto completo Resumen
National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: breast cancer [internet publication].Texto completo
Rugo HS, Rumble B, Macrae E, et al. Endocrine therapy for hormone receptor-positive metastatic breast cancer: American Society of Clinical Oncology Guideline. J Clin Oncol. 2016 Sep 1;34(25):3069-103.Texto completo Resumen
Giordano SH, Franzoi MAB, Temin S, et al. Systemic therapy for advanced human epidermal growth factor receptor 2-positive breast cancer: ASCO guideline update. J Clin Oncol. 2022 Aug 10;40(23):2612-35.Texto completo Resumen
Van Poznak C, Somerfield MR, Barlow WE, et al. Role of bone-modifying agents in metastatic breast cancer: an American Society of Clinical Oncology-Cancer Care Ontario focused guideline update. J Clin Oncol. 2017 Dec 10;35(35):3978-86.Texto completo Resumen
Artículos de referencia
Una lista completa de las fuentes a las que se hace referencia en este tema está disponible para los usuarios con acceso a todo BMJ Best Practice.
Diferenciales
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Más DiferencialesGuías de práctica clínica
- NCCN clinical practice guidelines in oncology: genetic/familial high-risk assessment: breast, ovarian, pancreatic, and prostate
- NCCN clinical practice guidelines in oncology: breast cancer
Más Guías de práctica clínicaFolletos para el paciente
Breast cancer, locally advanced: what is it?
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Más Folletos para el paciente
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