Metastatic Breast Cancer (Canada) Top 10 Priorities

  1. What biomarkers or intrinsic features of the tumour can be used to identify response to specific treatments and dosing schedules?
  2. What is the role of immunotherapy for metastatic breast cancer?
  3. How can treatment resistance be delayed, and minimized?
  4. What causes (i.e. cellular, genomic changes) breast cancer cells to metastasize, and what changes allow them to penetrate the blood-brain barrier?
  5. What is the right sequence of therapy in metastatic breast cancer?
  6. Does local therapy (radiation or surgery to sites of metastatic disease) improve survival outcomes in metastatic breast cancer?
  7. Is continuous treatment with systemic therapy (including HER2-targeted therapy and chemotherapy) better than intermittent treatment?
  8. Does early palliative care improve outcomes for metastatic breast cancer patients?
  9. What are the best methods of education for patients around treatment options and decision making that can lead to improved patient outcomes?
  10. Can safer, more accurate methods, including blood tests of detecting spread of disease (including following curative intent treatment) be developed?

The following questions were also discussed and put in order of priority at the workshop:

  1. What blood tests, including cell‐free DNA or circulating tumour cells, can be used to identify tumour mutations?
  2. Can complimentary therapies (including yoga, visualization, mediation) or what combinations of complimentary therapies with standard medicine, can have a meaningful impact on disease progression, symptom control, or quality of life of metastatic breast cancer patients?
  3. What is the role of genomics for metastatic breast cancer patients?
  4. Is there a benefit for surveillance (monitoring after treatment for early breast cancer)/early detection of metastatic disease?
  5. What are the best treatment options for specific sites of disease (ie, liver, lung, bone), and can individual metastases be treated differently?
  6. How can treatments be developed that are targeted for individuals?
  7. Can stem cells be used in the treatment of breast cancer?
  8. How often should imaging be performed, and what type of imaging (eg, CT scan, MRI, PET scan) is best for patients with metastatic breast cancer?
  9. Does marijuana or its derivatives have a meaningful impact on disease progression, symptom control and/or the quality of life of metastatic breast cancer patients?
  10. Can naturopathic therapies, or what combinations of naturopathic therapies with standard medicine, improve the outcomes (survival and quality of life) of metastatic breast cancer patients?
  11. Can nutrition, including specific foods or beverages, influence the course (positive or negative) of metastatic breast cancer?
  12. Can lifestyle changes (including exercise and physiotherapy and sleep patterns) improve survival and/or quality of life for patients with metastatic breast cancer?
  13. What are the best non‐narcotic options for pain control?
  14. What are the true long term toxicities of chemotherapy and targeted therapies, and what are the best ways to manage them (ie, lymphedema, neuropathy)?
  15. Does a strong relationship and open communication with clinicians and professional counsellors improve the quality of life for families dealing with metastatic breast cancer?
  16. What are the best and most effective interventions for preparing a patient for end of life?
  17. What can be done to improve or prevent “chemotherapy brain (brain fog)” or changes in cognition associated with systemic therapies?