From the Guidelines
A visceral crisis in breast cancer patients is defined as severe organ dysfunction, as assessed by signs and symptoms, laboratory studies, and rapid progression of disease, requiring immediate intervention with the most rapidly efficacious therapy. This condition typically involves vital organs such as the liver, lungs, or brain, characterized by significant symptoms, abnormal laboratory values, and rapid clinical deterioration 1. Patients may experience severe pain, respiratory distress, altered mental status, or organ failure depending on the affected sites. Visceral crisis represents an oncologic emergency necessitating urgent medical attention and aggressive treatment approaches. The goal is to achieve quick disease control to stabilize organ function and alleviate symptoms.
- Key characteristics of visceral crisis include:
- Severe organ dysfunction
- Rapid progression of disease
- Significant symptoms and abnormal laboratory values
- Immediate threat to life
- Treatment typically involves the use of the most rapidly efficacious therapy, which may not necessarily be chemotherapy in all situations, as noted in the updated guidelines 1.
- It is essential to distinguish between visceral crisis and the mere presence of visceral metastases, as the former requires immediate intervention to prevent further deterioration and potential organ failure.
- The management of visceral crisis should be personalized to meet the needs of the individual patient, taking into account their overall health, disease status, and treatment goals, as emphasized in the guidelines 1.
From the Research
Definition of Visceral Crisis
- Visceral crisis in breast cancer is a critical scenario where the burden of metastatic disease results in rapid deterioration of organ functions 2.
- It is a life-threatening clinical condition requiring urgent treatment and accounts for 10-15% of new advanced breast cancer diagnoses, mainly hormone receptor-positive/human epidermal growth factor 2 negative 3.
- Visceral crisis is defined as severe organ dysfunction requiring rapidly efficacious therapy, such as liver dysfunction, respiratory dysfunction, superior vena cava syndrome, or bone marrow carcinomatosis 4.
Clinical Characteristics and Prognosis
- Patients with visceral crisis have a dismal prognosis, with a mean time between visceral crisis and death of 4.7 weeks 5.
- The prognosis varies in different types of visceral crisis, with patients with bone marrow metastasis having the best prognosis and those with diffuse liver metastasis having the worst 6.
- The Eastern Cooperative Oncology Group (ECOG) scores and type of visceral crisis are associated with survival 6.
Management and Treatment
- International guidelines recommend combined chemotherapy as first-line treatment for patients with visceral crisis, but with modest results and a very poor prognosis 3.
- The role of chemotherapy in the treatment of visceral crisis is being questioned, with endocrine therapy plus CDK4/6 inhibitors yielding similar response rates and better quality of life in hormone receptor-positive breast cancer 2.
- Novel effective drugs, such as antibody-drug conjugates, are emerging and may play a role in the treatment of visceral crisis 2.
- Paclitaxel plus bevacizumab therapy has shown favorable efficacy and safety in treating patients with visceral crisis 4.