全球的乳腺癌专家向研究人员、学者、制药公司、资助者和倡导者发出倡议，号召加强晚期乳腺癌方面高质量的研究和临床试验。晚期乳腺癌是一种几乎致命的疾病，尚有诸多谜团有待解答。

最新的“晚期乳腺癌诊治国际指南” 同步发表在顶尖癌症期刊The Breast和Annals of Oncology上,专家们表示"急需"深入研究和临床试验，以寻求以下乳腺癌病情的治疗方法:

    乳腺癌扩散至肝脏或肺部周边(胸膜腔)或皮肤;

    HER2阳性晚期乳腺癌患者在使用曲妥珠单抗辅助治疗期间或治疗后病情复发;

    乳腺癌四期患者(乳腺癌已扩散至身体其他部位)手术去除原发性肿瘤是否能够提高存活率和生命质量;

    男性晚期乳腺癌患者需要接受芳香化酶抑制剂治疗（如阿那曲唑、依西美坦、来曲唑）；

此外，晚期乳腺癌还有许多其他领域需要进一步的研究和国际性多学科临床试验。还应加强保健专业医生的教育，使其在治疗乳腺癌患者时应用现有知识。

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

原文链接：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.