全球的乳腺癌專家向研究人員、學者、製藥公司、資助者和倡導者發出倡議，號召加強晚期乳腺癌方麵高質量的研究和臨床試驗。晚期乳腺癌是一種幾乎致命的疾病，尚有諸多謎團有待解答。

最新的“晚期乳腺癌診治國際指南” 同步發表在頂尖癌症期刊The Breast和Annals of Oncology上,專家們表示"急需"深入研究和臨床試驗，以尋求以下乳腺癌病情的治療方法:

乳腺癌擴散至肝髒或肺部周邊(胸膜腔)或皮膚;

HER2陽性晚期乳腺癌患者在使用曲妥珠單抗輔助治療期間或治療後病情複發;

乳腺癌四期患者(乳腺癌已擴散至身體其他部位)手術去除原發性腫瘤是否能夠提高存活率和生命質量;

男性晚期乳腺癌患者需要接受芳香化酶抑製劑治療（如阿那曲唑、依西美坦、來曲唑）；

此外，晚期乳腺癌還有許多其他領域需要進一步的研究和國際性多學科臨床試驗。還應加強保健專業醫生的教育，使其在治療乳腺癌患者時應用現有知識。

原文標題：ESO-ESMO 2nd international consensus guidelines for advanced breast cancer (ABC2)†

原文鏈接：http://annonc.oxfordjournals.org/content/early/2014/09/17/annonc.mdu385.full

作者：F. Cardoso、A. Costa、L. Norton、E. Senkus、M. Aapro、F. André、C. H. Barrios、J. Bergh、L. Biganzoli、K. L. Blackwell、M. J. Cardoso、T. Cufer、N. El Saghir、L. Fallowfield、D. Fenech、P. Francis、K. Gelmon、S. H. Giordano、J. Gligorov、A. Goldhirsch、N. Harbeck、N. Houssami、C. Hudis、B. Kaufman、I. Krop、S. Kyriakides、U. N. Lin、M. Mayer、S. D. Merjaver、E. B. Nordström、O. Pagani、A. Partridge、F. Penault-Llorca、M. J. Piccart、H. Rugo、G. Sledge、C. Thomssen、L. van't Veer、D. Vorobiof、C. Vrieling、N. West、B. Xu、E. Winer

introduction

Advanced breast cancer (ABC) is a treatable but still generally incurable disease. The goals of care are to optimize both length and quality of life. Due to continuous research, several advances have been made, particularly for the human epidermal growth factor receptor 2 (HER-2)-positive and for luminal-like subtypes. Notwithstanding these advances, median overall survival of patients with ABC is still only 2–3 years, although the range is wide [1–5], and survival may be longer for patients treated in specialized institutions [6]. Implementation of current knowledge is highly variable among countries and within each country.

The use of treatment guidelines has been associated with a significant improvement in survival [7–9]. This has been achieved mainly in early breast cancer. For ABC, and particularly metastatic breast cancer (MBC), less level 1 evidence exists and only recently has international consensus guidelines been developed (ABC1) [10]. The ABC Consensus Conference was created by the European School of Oncology (ESO) with the ambitious goal of improving outcomes for all patients with ABC. Backed by strong political advocacy, ABC guidelines are seeking to improve standards of care, to raise awareness about how to best meet to the needs of this underserved group of patients, and to identify research priorities, so that clinical research is focused on the most important areas of unmet need.

Following the work of the ESO-ABC Task Force [11–14], created in 2005, and the successful undertaking of the 1st International Consensus Guidelines Conference on ABC (ABC1), held in November 2011, the 2nd International Consensus Conference for Advanced Breast Cancer (ABC2) took place in Lisbon, Portugal, on 7–9 November 2013. The conference brought together about 1100 participants from 71 countries, including health professionals, patient advocates, and journalists. A series of guidelines were discussed and agreed upon, based on the most up-to-date evidence, and can be used to guide treatment decision-making in diverse health-care settings globally. These guidelines are developed as a joint effort from ESO and ESMO (European Society of Medical Oncology), are endorsed by EUSOMA (European Society of Breast Cancer Specialists), SIS (Senologic International Society), and Flam (Federación Latino Americana de Mastologia), and organized under the auspices of UICC (Union Internationale Contre Le Cancer), OECI (Organization of European Cancer Institutes), and the BCRF (Breast Cancer Research Foundation).

The present study summarizes the guidelines developed at ABC2. The guidelines include the level of evidence, the percentage of panel members who agreed with the consensus statements, and the supporting references for each recommendation. Importantly, the ABC guidelines are developed as clinical management recommendations potentially applicable worldwide, albeit with the necessary adjustments for each country, depending on access to therapies. The guidelines are based on the underlying principles of modern oncology, emphasizing the crucial role of a multidisciplinary and individualized approach that respects the specificities of the advanced setting and the preferences of each patient. The manuscript also clearly highlights areas where research efforts are urgently needed.