Pfizer Inc., working collaboratively with the European School of Oncology (ESO), within the scope of the Advanced Breast Cancer Third International Consensus Conference (ABC3), today released the Global Status of Metastatic Breast Cancer (MBC): A 2005 – 2015 Decade Report, which revealed both areas of improvement and substantial gaps in care, access to resources and support, and treatment outcomes for women with MBC.

MBC is the most advanced stage of breast cancer for which there is no cure.1 Further, public health experts estimate there will be a 43 percent increase in breast cancer related deaths globally from 2015 to 2030, the majority of which are a result of metastatic disease.2,3 Previous research has shown that women with MBC have distinct needs that are not often addressed and there are fewer patient and community resources available for these women compared with those for women with early-stage disease.4

Over the past decade - due to the collective efforts of the broader breast cancer community - some progress has been made to address the unique needs of women with MBC.5,6 However, there is still a great deal of improvement that needs to be made in this area. The findings from theGlobal Status of MBC: A Decade Report reinforce the urgent need for change in MBC care, patient support, research and the important role increased disease awareness can play.

This report is the most comprehensive analysis to date of the global advanced and metastatic breast cancer landscape over the past decade, and was developed with guidance from a global steering committee of multidisciplinary leaders in the MBC community. Results from the preliminary report were presented today at ABC3 in Lisbon, Portugal.7

As a result of these findings, ESO and members of the breast cancer community are calling for policymakers, advocates and the medical community to unite to develop a global charter as a call-to-action toward changing and improving MBC outcomes by the year 2025.

“As members of the global breast cancer community, we need to change the way we comprehend, research and prioritize metastatic breast cancer, a disease that is highly complex clinically and emotionally, yet has received far less attention than other forms of breast cancer,” said Fatima Cardoso, MD, director, Breast Cancer Unit at Champalimaud Clinical Center in Lisbon. “The Global Status of MBC: A Decade Report underscores the great challenges that continue to exist in the metastatic breast cancer landscape, and the need for worldwide unity in support of the hundreds of thousands of women living with the disease today.”8,9,10,11

The report includes three newly commissioned primary surveys examining current perceptions of the state of breast cancer in 34 countries around the world, including the first survey of global public perceptions of MBC. Secondary analyses were also conducted, and included an analysis of existing breast cancer resources and more than 3,000 previously published articles and abstracts, to determine the global landscape of MBC over the past decade. This analysis examined several key areas of MBC patient care and contains the first comprehensive analysis of the MBC scientific landscape.

“While significant progress has been made in the past few decades in our understanding of breast cancer, there is an unquestionable need for more research surrounding metastatic breast cancer worldwide,” said Liz Barrett, global president and general manager, Pfizer Oncology. “Through our work, we hope to leverage our scientific expertise and partnerships with the global breast cancer community to ultimately make metastatic breast cancer a chronic disease where patients can live with their condition and thrive as active contributors to their families and society.”

Beyond the results highlighted in the preliminary report, there is ongoing analysis of the policy and socioeconomic aspects of MBC, and additional findings will be presented in 2016.

For more information on the Global Status of MBC: A Decade Report, including methodology, please visit:www.BreastCancerVision.com.

Primary Survey Highlights

Three new studies evaluating the current state of breast cancer from the perspective of breast cancer care centers, patient support organizations and the general population found:

• More than half of 582 surveyed oncologists and other healthcare practitioners in the U.S., Europe, Latin America and Australia, report that they have not been trained on how to effectively deliver difficult information to their patients and have a desire for more training.12
• The majority of the 50 interviewed patient support organizations in North America, Europe, Asia Pacific, Latin America, Africa and the Middle East, recognize women with MBC require more support than those with early-stage disease, but report a range of barriers that can impact efforts to meet patient needs, including limited resources, cultural views and logistics.13
• There is a global lack of familiarity with metastatic or advanced breast cancer among the general public leading to widespread misperceptions about the disease, according to a survey of more than 14,000 people in 14 countries throughout Europe, Latin America, the Middle East, Africa and the Asia Pacific.14
  • The survey also found that among the general public, approximately 1 out of 5 people believe that those with metastatic breast cancer should keep their diagnosis a secret and not discuss their disease with anyone other than their physician, potentially contributing to the stigma that is associated with MBC and leading to feelings of isolation by the patient.13,15

These findings reinforce results from a 2014 survey conducted by Pfizer and breast cancer leaders in the United States that found the majority of Americans (60%) know little to nothing about MBC.16

Secondary Analysis Highlights

An analysis of more than 3,000 previously published articles and abstracts identified key limitations to progress for women with MBC over the past decade relating to patient care, the environmental landscape and scientific research, including:

• Despite the benefits of supportive and palliative care to the quality of life for patients, implementation of supportive care has been variable across certain countries and significant gaps remain.17,18,19,20,21
• Better psychological support for women with MBC is needed to ease the end-of-life care experience, particularly when it comes to anxieties about what they may experience.22,23
• There has not been a significant improvement in the quality of life for women with MBC in more than a decade, and there has even been a slight decrease since 2004.24,25,26,27,28,29
• The pace of innovation in MBC appears to have slowed in recent years with treatment advances, clinical research, publications and guideline development, particularly when compared with other tumor types, such as melanoma and lung cancer.30,31,32

About Metastatic Breast Cancer

MBC occurs when cancer spreads beyond the breast to other parts of the body, including the bones, lungs, liver and brain.1 An estimated 1.7 million new cases of breast cancer are diagnosed globally each year.7 Globally, five to 10 percent of newly diagnosed breast cancer patients will present with metastatic disease, however, in low- and middle-income countries 50-80 percent are initially diagnosed with advanced disease.8 In developed countries, approximately 20-30 percent of women diagnosed with early breast cancer progress to MBC, and this number may be higher in less developed countries.9,10

About Pfizer Oncology

Pfizer Oncology is committed to the discovery, investigation and development of innovative treatment options to improve the outlook for patients worldwide. Our strong pipeline of biologics and small molecules, one of the most robust in the industry, is studied with precise focus on identifying and translating the best scientific breakthroughs into clinical application for patients across a wide range of cancers. By researchers, cooperative research groups, governments, and licensing partners, Pfizer Oncology strives to cure or control cancer with breakthrough medicines, to deliver the right drug for each patient at the right time. For more information, please visit www.Pfizer.com.

About the European School of Oncology

The European School of Oncology (ESO) mission is to help improve the standards of treatment and care for cancer patients across Europe and to contribute through education to reducing the number of cancer deaths and to ensuring early diagnosis, optimal treatment, and holistic patient care.

To find out more about ESO, please visit: www.eso.net.

1 American Cancer Society. Detailed Guide: Breast Cancer.http://www.cancer.org/acs/groups/cid/documents/webcontent/003090-pdf.pdf. Accessed October 20, 2015.

2 World Health Organization. Projections of mortality and causes of death, 2015 and 2030.http://www.who.int/healthinfo/global_burden_disease/projections/en/. Updated July 2013. Accessed September 27, 2015.

3 Lu J, Steeg PS, Price JE, et al. Breast cancer metastasis: challenges and opportunities. Cancer Res. 2009;69:4951-4953.

4 Mayer M, Grober S. Silent Voices: Women with Advanced (Metastatic) Breast Cancer Share Their Needs and Preferences for Information, Support, and Practical Resources.http://www.lbbc.org/sites/default/files/LBBCsilentvoices.pdf. Accessed October 20, 2015.

5 Santa-Maria CA, Gradishar WJ. Changing Treatment Paradigms in Metastatic Breast Cancer: Lessons Learned. JAMA Oncol. 2015;1(4):528-534. doi:10.1001/jamaoncol.2015.1198.

6 Susan G. Komen. Living with Metastatic Breast Cancer. January 2014.http://ww5.komen.org/KomenPerspectives/Living-with-metastatic-breast-cancer-(January-2014).html. Accessed November 2, 2015

7 Presented by Dr. Fatima Cardoso at the ABC3 Breast Cancer Patient Advocacy Session: Worldwide Survey and Call to Action (9: 00-10:30 WET).

8 International Agency for Research on Cancer. Breast cancer: estimated incidence, mortality and prevalence worldwide in 2012. http://globocan.iarc.fr/Pages/fact_sheets_cancer.aspx.Accessed August 25, 2015.

9 Cardoso F, Costa A, Norton L, et al. 1st International consensus guidelines for advanced breast cancer (ABC1). Breast. 2012;21(3):242-252.

10 O’Shaughnessy. Extending Survival with Chemotherapy in Metastatic Breast Cancer. The Oncologist. 2005;10(suppl 3):20–29

11 Early Breast Cancer Trialists’ Collaborative Group (EBCTCG). Aromatase inhibitors versus tamoxifen in early breast cancer: patient-level meta-analysis of the randomised trials. The Lancet. 2015 July 24.http://dx.doi.org/10.1016/S0140-6736(15)61074-1

12 Breast Cancer Center Survey. Sponsored by Pfizer Oncology. August 2015

13 Patient Support Organization Survey. Sponsored by Pfizer Oncology. August 2015

14 General Public Survey. Sponsored by Pfizer Oncology. July 2015

15 Metastatic Breast Cancer Alliance. Changing the Landscape for People Living with Metastatic Breast Cancer. October 2014

16 United Stated General Public Survey. Sponsored by Pfizer Oncology. April 2014

17 EAPC. White paper on standards and norms for hospice and palliative care in Europe: Part 1. Eur J Pall Care. 2009;16(6):278-332.

18 Harding R, Selman L, Agupio G, et al. The prevalence and burden of symptoms amongst cancer patients attending palliative care in two African countries. Eur J Cancer. 47(1):51-56. http://dx.doi. org/10.1016/j.ejca.2010.08.003

19 Nuhu FT, Adebayo KO, Adejumo O. Quality of life of subjects with cancers in Ibadan, Nigeria. J Ment Health. 2013;22(4):325-33. doi:10.3109/09638237.2012.7346441–9.

20 Sepulveda C, Habiyambere V, Amandua J, Borok M, Kikule E, Mudanga B, et al. Quality care at the end-of-life in Africa. BMJ. 2003;327:209.

21 Jeremic B, Vanderpuye V, Abdel-Wahab S, Gaye P, Kochbati L, Diwani M, et al. Patterns of practice in palliative radiotherapy in Africa – case revisited. Clin Oncol.

22 Neimeyer RA, Wittkowski J, Moser RP. Psychological research on death attitudes: an overview and evaluation. Death Studies. 2004;28(4):309-340.

23 Tomer A. (2000). Death related-attitudes: Conceptual distinctions. In Tomer A, ed. Death Attitudes and the Older Adult: Theories, Concepts and Applications. Philadelphia: Taylor and Francis; 2000.

24 Aranda, Sanchia, et al. Mapping the quality of life and unmet needs of urban women with mBC. European journal of cancer care 14.3 2005: 211-222.

25 Zhou, Xiaolei, et al. Lapatinib plus capecitabine versus capecitabine alone for HER2+ (ErbB2+) mBC: quality-of-life assessment. Breast cancer research and treatment 117.3 2009: 577-589.

26 Abernethy, Amy P., et al. Phase 2 pilot study of Pathfinders: a psychosocial intervention for cancer patients. Supportive care in cancer 18.7 2010: 893-898.

27 Reed, Elizabeth, et al. Quality of life and experience of care in women with mBC: a cross-sectional survey. Journal of pain and symptom management 43.4 2012: 747-758.

28 Kyrgidis, Athanassios, et al. Quality of life in breast cancer patients with bisphosphonate-related osteonecrosis of the jaws and patients with head and neck cancer: A comparative study using the EORTC QLQ-C30 and QLQ-HN35 questionnaires. Anticancer research 32.8 2012: 3527-3534.

29 Gupta, Shaloo, Jie Zhang, and Guy Jerusalem. The association of chemotherapy versus hormonal therapy and health outcomes among patients with hormone receptor-positive, HER2-negative mBC: experience from the patient perspective. Expert review of pharmacoeconomics & outcomes research 14.6 2014: 929-940.

30 Bernard-Marty C, Cardoso F, Piccart MJ. Facts and controversies in systemic treatment of metastatic breast cancer. Oncologist. 2004;9:617-632. (Bernard-Marty, 2004)

31 Altundag K, Ibrahim NK. Aromatase inhibitors in breast cancer: an overview. Oncologist. 2006;11:553-562. (Altundag, 2006)

32 Masters GA, Krilov L, Bailey HH, et al. Clinical cancer advances 2015: annual report on progress against cancer from the American Society of Clinical Oncology. J Clin Oncol. 2015;33(7):786-809. (Masters, 2015)