BS01 LOCALLY ADVANCED BREAST CANCER: NEED FOR A CO-ORDINATED, MULTIDISCIPLINARY APPROACH

Abstract

Historically, patients presenting with large, inoperable cancers were treated with radiation therapy alone or radiation therapy followed by surgical resection. The use of systemic therapy in patients with locally advanced breast cancer (LABC) has led to improved disease outcome when compared with surgery or radiotherapy alone. In comparison with operable breast cancer, there is a relative paucity of randomised trials evaluating systemic therapy for LABC. Of the randomised trials published, a statistically significant survival benefit is only demonstrated in a few. The difficulties in performing large randomised trials in LABC relate to several issues. The classification of LABC which includes T3, T4, and N2 disease incorporates a heterogeneous group of patients. There is a variable approach taken by clinicians in terms of the type of pre-operative chemotherapy used, sequencing of locoregional therapy and whether post-operative adjuvant systemic therapy is also given. To date, the efficacy of systemic therapy in LABC has largely been established from results of non-randomised Phase II studies. These studies compare favourably to historical data with higher 5- and 10-year disease-free and overall survival. A common finding in several trials of pre-operative systemic treatment is that the rates of breast conserving surgery is increased and those patient achieving a complete pathological response have superior disease outcomes than those who do not. An overview of trials supporting the current management of LABC will be presented. The objectives and preliminary findings of a multicentre study initiated in Perth for women with LABC will also be discussed.