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  • Review Article
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Management of locally advanced breast cancer—perspectives and future directions

Nature Reviews Clinical Oncology volume 12, pages 147–162 (2015)Cite this article

Subjects

A Corrigendum to this article was published on 14 April 2015

This article has been updated

Key Points

  • The definition of locally advanced breast cancer (LABC) can be broadened to include large operable tumours, however, we commonly use this term to refer to inoperable cancers

  • The management of LABC constitutes an important clinical problem, particularly in developing countries and those without widely adapted awareness programmes

  • The optimal management of LABC requires a multidisciplinary approach and collaboration between medical, surgical and radiation oncologists

  • Few data exist on LABC systemic treatment; the majority of data are from studies including both large-operable and locally advanced inoperable tumours—posing many challenges in the management of LABC

  • Several new molecularly targeted agents are under clinical investigation aiming to improve the clinical outcome of patients with LABC

  • The negative results of the ALTTO trial after promising data from NeoALTTO advocate a reassessment of pathological complete response as a suitable surrogate marker for long-term outcome in breast cancer

Abstract

Locally advanced breast cancer (LABC) constitutes a heterogeneous entity that includes advanced-stage primary tumours, cancers with extensive nodal involvement and inflammatory breast carcinomas. Although the definition of LABC can be broadened to include some large operable breast tumours, we use this term to strictly refer to inoperable cancers that are included in the above-mentioned categories. The prognosis of such tumours is often unfavourable; despite aggressive treatment, many patients eventually develop distant metastases and die from the disease. Advances in systemic therapy, including radiation treatment, surgical techniques and the development of new targeted agents have significantly improved clinical outcomes for patients with this disease. Notwithstanding these advances, LABC remains an important clinical problem, particularly in developing countries and those without widely adapted breast cancer awareness programmes. The optimal management of LABC requires a multidisciplinary approach, a well-coordinated treatment schedule and close cooperation between medical, surgical and radiation oncologists. In this Review, we discuss the current state of the art and possible future treatment strategies for patients with LABC.

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Figure 1: Current management approach for patients with LABC and IBC.

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Change history

  • 14 April 2015

    In the version of this article originally published online and in print, the word 'radiotherapy' was missing in figure 1 from one of the boxes. Additionally, several of the boxes had been merged, which meant the order of treatments was unclear. The figure has now been corrected for the HTML and PDF versions of the article published online.

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Acknowledgements

K.T. has received grants from FOCA (Fonds Cancer-Belgium) and the Hellenic Society of Medical Oncology (HeSMO).

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Authors and Affiliations

  1. European Organisation for Research and Treatment of Cancer (EORTC) Headquarters & Breast Cancer Group, Avenue Mounier 83/11, Brussels, 1200, Belgium

    Konstantinos Tryfonidis

  2. Department of Oncology and Radiotherapy, Medical University of Gdansk, Ul Debinki 7, Gdansk, 80211, Poland

    Elzbieta Senkus

  3. Breast Unit, Champalimaud Clinical Centre, Avenida De Brasília s/n, Lisbon, 1400-038, Portugal

    Maria J. Cardoso & Fatima Cardoso

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  1. Konstantinos Tryfonidis
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K.T., E.S., M.J.C. and F.C. researched data for article, reviewed and edited the manuscript before submission, provided substantial contribution to discussion of content and wrote the manuscript.

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Correspondence to Fatima Cardoso.

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E.S. is an advisory board member for Roche, has received travel support from Novartis and belongs to the speakers' bureau for AstraZeneca, GSK and Roche. F.C. has received Consultant/honouraria and is an advisory board member for Astellas, Astra-Zeneca, Celgene, Daiichi-Sankyo, Eisai, Genentech/Roche, GE Oncology, GlaxoSmithKline, Merck-Sharp, Merus, Novartis, Pfizer, and Sanofi. K.T. and M.J.C. have no competing interests.

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Tryfonidis, K., Senkus, E., Cardoso, M. et al. Management of locally advanced breast cancer—perspectives and future directions. Nat Rev Clin Oncol 12, 147–162 (2015). https://doi.org/10.1038/nrclinonc.2015.13

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