Comparison of 4th ESO–ESMO international consensus guidelines for advance breast cancer and Chinese anti-cancer association committee of Breast Cancer Society guideline. (June 2019)

• Record Type: Journal Article
• Authors: Hu, Xichun; Li, Ting; Wang, Biyun; Zhang, Jian; Yu, Xiaoli; Shao, Zhimin
• Is Part Of: Breast. Volume 45(2019)
• Page Start: 36
• Page End: 42
• Publication Date: 2019-06
• Subjects: ABC4 guideline -- CBCS guideline -- Advance breast cancer; Breast -- Diseases -- Periodicals; Breast -- Tumors -- Periodicals; Breast -- Periodicals; Electronic journals; Periodicals; 616
• DOI: 10.1016/j.breast.2019.02.009
• Languages: English
• ISSNs: 0960-9776

Abstract

Abstract: The primary aim of the international advance breast cancer (ABC) guidelines are to guide treatment decisions in many different healthcare settings, but need adaptations due to different access to care. These guidelines are based on the most up-to-date evidence. However, Chinese experts have a different national condition and policies to face. The Chinese Anti-Cancer Association Committee of Breast Cancer Society guideline (CBCS guideline) is to guide treatments and to reflect unmet needs of Chinese breast cancer patients. Although, most of the recommendations in the two guidelines are the same, some of them are different. In this article, with regard to country-specific peculiarities, a working group of Chinese breast cancer experts compare the similarities and differences between the ABC guideline and CBCS guideline and commented on the voting results of the ABC panelists. We also discuss why these differences exist, such as lack of access, different tumor biology and epidemiology, and even different culture. The money which patients have to pay out of pocket for their medical cost and the availability of drugs lie at the heart of the issues of guideline differences. Highlights: China's universal medical insurance system has three main types of publicly financed insurance, including urban employee basic medical insurance, urban resident basic medical insurance and new cooperative medical scheme, covering about 97.5% of the entire population. However, the quality of overall medical services is not satisfactory. About 43% of Chinese cancer patients suffered from catastrophic health expenditure, and the situation needs lots of reforms. Fortunately, the seventeen anti-tumor targeted drugs have just been included into the Catalogue of Drugs for Basic National Medical Insurance in 2018. For HER-2 positive inoperable LABC and metastatic breast cancer, dual HER2 blockade is not recommended in CBCS guideline because anti-HER2 treatments are very expensive and patients have to pay a lot out of pocket even for medical insurance covered drugs. Doublet chemotherapy (docetaxel + capecitabine) plus trastuzumab is recommended although it is a suboptimal option. Doublet chemotherapy is more commonly prescribed in China than in Western countries. There are three main reasons. First, doctors want to improve the efficacy or mitigate drug-related specific toxicity (e.g. docetaxel-related febrile neutropenia). Second, professional promotion of Chinese doctors requires a lot of publications, so we design many combination chemotherapy trials since combination provides more space to optimize treatment. Third, a rapid tumor shrinkage or symptom relief with the combination will improve patient's compliance in China. As for TNBC, Chinese experts are more in favor of cisplatin-containing than carboplatin-containing regimens. There are mainly four reasons. First, cisplatin-containing doublet with gemcitabine is published in high-impact factor journals which was listed as level Ib evidence in German AGO guideline. Second, the hospitalization fee is covered by medical insurance here in China. Third, cisplatin has a higher anti-tumor activity than carboplatin, although there is no survival gain. Last, carboplatin related thrombocytopenia is tough to manage.