Systemic therapy for endocrine therapy refractory HR-positive, HER2-negative metastatic breast cancer

Patients with endocrine therapy refractory disease have experienced progression or poor tolerance of two or more prior lines of therapy that have incorporated endocrine agents. Treatment aims to maintain quality of life and extend survival, but is not curative. As such, the patient's comorbidities, preferences, and goals strongly influence treatment decisions. Treatment may also be influenced by site of disease (eg, intracranial metastases). At any point, patients may reasonably elect for interventions focused on comfort and symptom control, without systemic anti-cancer therapy. Early involvement of palliative care specialists can be helpful.

HR: hormone receptor; HER2: human epidermal growth factor 2; ISH: in situ hybridization.

* Preferred single-agent options include a taxane or capecitabine. Other options include anthracyclines, eribulin, or vinorelbine. Rarely, patients with symptomatic disease with heavy visceral disease burden will benefit from combination chemotherapy.

¶ Monitoring includes history, physical exam, comprehensive metabolic panel, and complete blood count prior to the start of each treatment cycle; repeat imaging studies after several cycles; and serial assay of tumor markers, if they were elevated at baseline.

Δ For patients with severe underlying lung disease, T-DxD may not be appropriate due to the risk of pneumonitis with this drug.

◊ It is not known whether patients with HER2-low metastatic breast cancer who have progressed on T-DxD will have a good response to SG, since both drugs have a topoisomerase-1 cytotoxic agent. In our practice, we do not routinely sequence these drugs, and instead go to a non-cross resistant drug, unless the T-DxD was stopped for intolerance.

Graphic 139772 Version 1.0

خرید پکیج

Systemic therapy for endocrine therapy refractory HR-positive, HER2-negative metastatic breast cancer