Treatments for nonmetastatic breast cancer

	HR-positive/ HER2-negative	HR-positive or HR-negative/ HER2-positive	HR-negative/ HER2-negative
Surgery?	Yes	Yes	Yes
Chemotherapy?	In high risk cases*	Yes^¶	Yes^¶
Immunotherapy?	No	No	In high-risk cases
Endocrine therapy?	Yes	In HR-positive disease	No
Anti-HER2 therapy?	No	Yes	No
Radiation?	Typically after BCS, sometimes after mastectomy^Δ	Typically after BCS, sometimes after mastectomy^Δ	Typically after BCS, sometimes after mastectomy^Δ

This table provides a broad framework for the management of early breast cancer. Patients with nonmetastatic breast cancer are treated with curative intent. Decisions are typically nuanced, however, and treatments should be individualized and determined in a multidisciplinary setting involving input from surgeons, and medical and radiation oncologists.

HR: hormone receptor; HER2: human epidermal growth factor 2; BCS: breast conserving surgery.

* Most patients proceed directly to surgery, and pathologic findings will influence whether postoperative chemotherapy is administered. However, select patients with larger HR-positive/HER2-negative tumors or bulky lymph nodes will be offered preoperative treatment.

¶ Most cancers that are either HER2-positive (irrespective of hormone receptor status) or hormone receptor-negative/HER2-negative will be treated with chemotherapy, although exceptions might be made for very small (a few mm or less) tumors. Typically chemotherapy is administered prior to surgery, as the response to treatment drives postoperative decisions regarding systemic therapy and provides prognostic information. Further chemotherapy may be administered after surgery, depending on the response to treatment.

Δ Most patients receive radiation after BCS. Select older females with small, HR-positive, HER2-negative tumors who will take endocrine therapy may have the option of omitting radiation. For patients who have had mastectomy, reasons for radiation include lymph node involvement or a combination of high-risk features such as young age, lymphovascular invasion, etc.

Graphic 142348 Version 1.0

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Treatments for nonmetastatic breast cancer