Abstract
Breast cancer remains an incurable disease, causing about 630 000 deaths in 2018 worldwide. 1 Bray F Ferlay J Soerjomataram I Siegel RL Torre LA Jemal A Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018; 68: 394-424 Crossref PubMed Scopus (50356) Google Scholar A better understanding of the underlying biology and the availability of more active drugs have substantially extended life expectancy in some subsets of patients with metastatic breast cancer. 2 Caswell-Jin JL Plevritis SK Tian L et al. Change in survival in metastatic breast cancer with treatment advances: meta-analysis and systematic review. JNCI Cancer Spectr. 2018; 2pky062 Crossref PubMed Google Scholar New drug approvals are dependent on randomised clinical trials that test new treatments head-to-head against standards of care. Although this methodology is pivotal in clinical research, in practice, patients with metastatic breast cancer receive different treatments sequentially across multiple progressions of their disease. 3 Seah DS Luis IV Macrae E et al. Use and duration of chemotherapy in patients with metastatic breast cancer according to tumor subtype and line of therapy. J Natl Compr Canc Netw. 2014; 12: 71-80 Crossref PubMed Scopus (30) Google Scholar Due to a paucity of studies that specifically address treatment sequencing, guidelines recommend first and further lines of treatment on the basis of the results of separate randomised trials specifically conducted in each line of therapy. 4 National Comprehensive Cancer NetworkBreast cancer (version 1.2019). https://www.nccn.org/professionals/physician_gls/pdf/breast_blocks.pdfDate: 2019 Date accessed: April 22, 2019 Google Scholar With the growing number of therapeutic options with overlapping indications, treatment sequencing is becoming a critical issue both in research and clinical practice. 5 Caffo O Treatment sequencing in oncology: balancing clinical trial and real-world evidence. Future Oncol. 2019; 15: 2887-2889 Crossref PubMed Scopus (4) Google Scholar
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