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A definition for aggressive disease in patients with HER-2 negative metastatic breast cancer: an expert consensus of the Spanish Society of Medical Oncology (SEOM)

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Abstract

Purpose

To converge on an expert opinion to define aggressive disease in patients with HER2-negative mBC using a modified Delphi methodology.

Methods

A panel of 21 breast cancer experts from the Spanish Society of Medical Oncology agreed upon a survey which comprised 47 questions that were grouped into three sections: relevance for defining aggressive disease, aggressive disease criteria and therapeutic goals. Answers were rated using a 9-point Likert scale of relevance or agreement.

Results

Among the 88 oncologists that were invited to participate, 81 answered the first round (92%), 70 answered the second round (80%), and 67 answered the third round (76%) of the survey. There was strong agreement regarding the fact that identifying patients with aggressive disease needs to be adequately addressed to help practitioners to decide the best treatment options for patients with HER2-negative mBC. The factors that were considered to be strongly relevant to classifying patients with aggressive HER2-negative mBC were a high tumor burden, a disease-free interval of less than 12–24 months after surgery, the presence of progressive disease during adjuvant or neoadjuvant chemotherapy and having a triple-negative phenotype. The main therapeutic goals were controlling symptoms, improving quality of life and increasing the time to progression and overall survival.

Conclusions

High tumor burden, time to recurrence after prior therapy and having a triple-negative phenotype were the prognostic factors for which the greatest consensus was found for identifying patients with aggressive HER2-negative mBC. Identifying patients with aggressive disease leads to different therapeutic approaches.

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Acknowledgements

The authors wish to thank Fernando Rico-Villademoros and Teresa Hernando from Cociente SL (Madrid, Spain) for their help in preparing the first draft of this manuscript; this assistance was funded by Roche Farma. The authors made all of the decisions regarding the final content of this manuscript. All authors have approved the final version of the submitted manuscript.

Author information

Authors and Affiliations

  1. Medical Oncology Department, MD Anderson Cancer Center, C/Arturo Soria, 270, 28033, Madrid, Spain

    A. González

  2. Hematology and Oncology Department, Hospital Clínico Universitario de Valencia, Valencia, Spain

    A. Lluch

  3. Medical Oncology Department, Hospital Universitario Virgen de la Victoria, Málaga, Spain

    E. Aba

  4. Medical Oncology Department, Hospital Parc de Salut Mar, Barcelona, Spain

    J. Albanell

  5. Medical Oncology Department, Hospital Miguel Servet, Zaragoza, Spain

    A. Antón

  6. Medical Oncology Department, Hospital Universitario Donostia, San Sebastián, Spain

    I. Álvarez

  7. Medical Oncology Department, Hospital Universitario Morales Meseguer, Murcia, Spain

    F. Ayala

  8. Medical Oncology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain

    A. Barnadas

  9. Medical Oncology Department, Complejo Hospitalario Universitario de La Coruña, La Coruña, Spain

    L. Calvo

  10. Medical Oncology Department, Hospital Universitario 12 de Octubre, Madrid, Spain

    E. Ciruelos

  11. Medical Oncology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain

    J. Cortés

  12. Medical Oncology Department, Hospital Universitario Reina Sofía, Córdoba, Spain

    J. de la Haba

  13. Medical Oncology Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain

    J. M. López-Vega

  14. Medical Oncology Department, Fundación Hospital Provincial de Castellón, Castellón, Spain

    E. Martínez

  15. Medical Oncology Department, Hospital Clínic de Barcelona, Barcelona, Spain

    M. Muñoz

  16. Medical Oncology Department, Hospital de Cabueñes, Gijón, Spain

    I. Peláez

  17. Medical Oncology Department, Hospital Universitario La Paz, Madrid, Spain

    A. Redondo

  18. Medical Oncology Department, Hospital General Universitario de Elche, Elche, Spain

    Á. Rodríguez

  19. Medical Oncology Department, Hospital Universitario de Salamanca-IBSAL, Salamanca, Spain

    C. A. Rodríguez

  20. Instituto Valenciano de Oncología, Valencia, Spain

    A. Ruíz

  21. Medical Oncology Department, Hospital Universitario Arnau Vilanova, Lleida, Spain

    A. Llombart

Authors
  1. A. González
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  2. A. Lluch
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  3. E. Aba
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  4. J. Albanell
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  5. A. Antón
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  6. I. Álvarez
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  7. F. Ayala
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  8. A. Barnadas
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  9. L. Calvo
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  10. E. Ciruelos
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  11. J. Cortés
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  12. J. de la Haba
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  13. J. M. López-Vega
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  14. E. Martínez
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  15. M. Muñoz
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  16. I. Peláez
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  17. A. Redondo
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  18. Á. Rodríguez
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  19. C. A. Rodríguez
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  20. A. Ruíz
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  21. A. Llombart
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Corresponding author

Correspondence to A. González.

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Conflict of interest

A. González has received honoraria for lectures and advisory boards from Roche; A. Lluch has received consultant fees from Novartis, Roche, Pfizer; E. Aba has received honoraria for advisory boards from Roche and Celgene, and honoraria for lectures from Roche, Novartis, and Celgene; J. Albanell has received honoraria for advisory board from Roche; I. Álvarez has received honoraria for consultancy, lectures and clinical research from Roche, AstraZeneca, Novartis, and Lilly; F. Ayala has received honoraria for consultancy and advisory boards from Novartis and Celgene, and has received support for travel, accommodations and expenses from Roche and Celgene; A. Barnadas has received honoraria for advisory board from Pfizer, Astra Zeneca, and Roche, for speaker bureau from Pfizer, Astra Zeneca, Roche, and Novartis; J. Cortés has received consultancy fees from Roche/Genentecha and Celgene, honoraria for lectures from Celgene, Novartis, Eisai, and Roche/Genentech, and has ownership interest in MedSIR; J. de la Haba has received honoraria for advisory boards from Roche, Pierre-Fabre, Genomics Health, Astra Zeneca, Celegene, Agendia, and GSK, and has received honoraria for lectures from Roche, Astra Zeneca, Agendia, Celgene, Pierre-Fabre, and Novartis; E. Martínez has received honoraria for lectures and advisory board from Roche; M. Muñoz has received consultancy fees from Roche; A. Redondo has received honoraria for advisory boards from Roche, and Astra Zeneca, honoraria for lectures from Roche, Astra Zeneca, and Pharmamar, and research grants from Roche; A. Llombart has received honoraria for advisory boards from Roche, Pfizer, Lilly, Novartis, and AstraZeneca, honoraria for lectures from Roche, Astra Zeneca, Novartis, Pfizer, and Celgene; A. Antón L. Calvo, E. Ciruelos, J.M. López-Vega, I. Peláez, Á. Rodríguez, C.A. Rodríguez, and A. Ruíz have declared no conflict of interest.

Ethical standards

The manuscript does not contain clinical studies or patient data.

Funding

Sources of support: This work was supported by Roche Farma.

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González, A., Lluch, A., Aba, E. et al. A definition for aggressive disease in patients with HER-2 negative metastatic breast cancer: an expert consensus of the Spanish Society of Medical Oncology (SEOM). Clin Transl Oncol 19, 616–624 (2017). https://doi.org/10.1007/s12094-016-1571-4

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  • DOI: https://doi.org/10.1007/s12094-016-1571-4

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