European oncologists' preferences for the management of breast cancer: case presentations and expert commentary.

The development of new cytotoxic and biological agents has brought a welcome extension in the range of therapeutic options available to women with both early-stage and advanced breast cancer. Among the most significant recent developments has been the recognition of HER2 as a prognostic factor and target for treatment. In a series of meetings across Europe, 230 experienced oncologists and an expert faculty discussed and voted on how best to treat five women whose cases were chosen to bring out important issues in treatment. In most cases, a range of options were considered appropriate, and intriguing differences emerged between countries in the choices preferred. The following represents a very abbreviated outline of the cases and the management decisions made. Case 1, symptomatic, visceral, metastatic disease overexpressing HER2: most favoured option, trastuzumab plus docetaxel. Case 2, adjuvant chemotherapy in high-risk, hormone-negative, HER2-positive disease: favoured option, FEC-100 for three cycles, followed by three cycles of docetaxel (trastuzumab also given). Case 3, adjuvant endocrine therapy in a postmenopausal woman with hormone-positive, HER2-negative disease: favoured option, tamoxifen for two years followed by aromatase inhibitor (either exemestane or anastrozole). Case 4, inflammatory HER2-positive breast cancer progressing on FEC-100: favoured option, switch to a taxane plus trastuzumab. Case 5, a young woman with hormone-negative, HER2-positive disease who develops symptomatic visceral metastases a year after adjuvant FEC-100 and trastuzumab: favoured option, enrollment in a clinical trial of the HER2 tyrosine kinase inhibitor lapatinib alone or in combination with trastuzumab or chemotherapy. Together, the expression of these preferences and the discussions that followed provide a valuable insight into current practice at a time of exceptionally rapid change in the management of breast cancer.