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Objective: During clinical practice, it can be challenging, given the lack of response biomarkers, to identify the patients with metastatic breast cancer (mbca) who would benefit most from the addition of bevacizumab to first-line standard chemotherapy. The aim of the present review was to summarize the relevant scientific evidence and to discuss the experience of a group of experts in using bevacizumab to treat mbca. Methods: A panel of 17 Spanish oncology experts met to discuss the literature and their experience in the use of bevacizumab as first-line treatment for mbca. During the meeting, discussions focused on three main issues: the profile of the patients who could benefit most from bevacizumab, the optimal bevacizumab treatment duration, and the safety profile of bevacizumab. Results: The subset of mbca patients who would benefit the most from the addition of bevacizumab to first-line standard chemotherapy are those with clinically defined aggressive disease. Treatment with bevacizumab should be maintained until disease progression or the appearance of unacceptable toxicity. In the mbca setting, the toxicity profile of bevacizumab is well known and can be managed in clinical practice after adequate training. Conclusions: This expert group recommends administering bevacizumab as first-line treatment in patients with clinically aggressive disease.

Resumen El cancer de mama es la neoplasia mas frecuente en la mujer, siendo su etiologia desconocida y probablemente relacionada con multiples factores. Suele presentarse como masa, siendo imprescindible realizar una prueba de imagen mamaria y biopsiar las lesiones sospechosas. En los estadios precoces o localmente avanzados, el tratamiento incluye la cirugia (conservadora si es posible) seguida de tratamiento adyuvante: radioterapia (si cirugia conservadora y/o afectacion ganglionar), quimioterapia si se considera indicada (en ocasiones como tratamiento sistemico primario), trastuzumab (tumores HER2 positivos) y hormonoterapia (tumores con sobreexpresion de receptores hormonales). En caso de existir metastasis a distancia los objetivos principales del tratamiento son el mantenimiento de la calidad de vida y el aumento de la supervivencia. En funcion de las caracteristicas del tumor y de la localizacion de las metastasis, pueden utilizarse tratamientos sistemicos (hormonoterapia, quimioterapia y agentes biologicos) combinados o no con tratamientos locales como la cirugia y la radioterapia.