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Hormone Receptor Positive Metastatic Breast Cancer
Transcript of Hormone Receptor Positive Metastatic Breast Cancer
Breast cancer is the most frequently diagnosed cancer and the leading cause of cancer-related death among females worldwide
In the US, up to 5% of women diagnosed with breast have metastatic disease at the time of first presentation
In addition, up to 30 percent of women with early-stage, non-metastatic breast cancer at diagnosis will develop distant metastatic disease
Although metastatic breast cancer is unlikely to be cured, meaningful improvements in survival have been seen
Role of estrogen
With the recognition that estrogen has an important role in the promotion and progression of hormone receptor-positive breast cancer, endocrine therapy is a principle component in the treatment of hormone-sensitive breast cancer in the adjuvant and metastatic settings
Patients with hormone receptor-positive metastatic breast cancer
Unless presenting with rapidly progressive visceral metastasis, then chemotherapy indicated
However, patients exhibiting a good clinical response to chemotherapy may be able to discontinue treatment and begin endocrine therapy
Choice of treatment depends on:
Prior treatment history
The primary goals of systemic treatment for metastatic breast cancer are:
prolongation of survival,
alleviation of symptoms, and
maintenance or improvement in quality of life
The median survival for metastatic breast cancer is 18 to 24 months, though this varies widely based on subtype of tumor, sites of metastatic involvement, and burden of metastatic disease.
~ 20 percent of hormone receptor positive breast cancer
Trastuzumab vs lapatinib
Tamoxifen or Arimidex
Prior Treatment History
Women who progress ≥12 months from the end of adjuvant endocrine therapy and patients who present with de novo metastatic breast cancer are eligible for first-line endocrine treatment.
Patients who progress on or within 12 months of completing adjuvant endocrine therapy are eligible for second-line endocrine treatment. Patients who progress on first-line endocrine therapy for metastatic disease are also eligible for second-line treatment.
For women who progress after two lines of endocrine therapy, treatment should be based on their prior treatment response, tumor burden, and individual preferences.
For premenopausal women, trastuzumab plus tamoxifen rather than in combination with ovarian suppression due to insufficient results
For postmenopausal women, we suggest trastuzumab plus anastrozole
Estrogen has an important role in the promotion and progression of hormone receptor-positive breast cancer.
As a result, endocrine therapy has become a principal component in the treatment of hormone-sensitive breast cancer in the adjuvant and metastatic settings.
For women with hormone receptor-positive, HER2-positive breast cancer, we recommend first-line endocrine therapy plus HER2-targeted therapy rather than endocrine therapy alone (Grade 1B).
Trastuzumab rather than lapatinib
Sawka CA, Pritchard KI, Shelley W, et al. A randomized crossover trial of tamoxifen versus ovarian ablation for metastatic breast cancer in premenopausal women: a report of the National Cancer Institute of Canada Clinical Trials Group (NCIC CTG) trial MA.1. Breast Cancer Res Treat 1997
Carlson RW, Theriault R, Schurman CM, et al. Phase II trial of anastrozole plus goserelin in the treatment of hormone receptor-positive, metastatic carcinoma of the breast in premenopausal women. J Clin Oncol 2010
Park IH, Ro J, Lee KS, et al. Phase II parallel group study showing comparable efficacy between premenopausal metastatic breast cancer patients treated with letrozole plus goserelin and postmenopausal patients treated with letrozole alone as first-line hormone therapy. J Clin Oncol 2010
Finn RS, Dering J, Conklin D, et al. PD 0332991, a selective cyclin D kinase 4/6 inhibitor, preferentially inhibits proliferation of luminal estrogen receptor-positive human breast cancer cell lines in vitro. Breast Cancer Res 2009
Trastuzumab after Adjuvant Chemotherapy in HER2-Positive Breast Cancer
2005 study sampled ~3400 women with HER2 positive breast cancer.
Half received tratuzumab for 1 year, other half underwent observation
Conclusion: 1 year of treatment with trastuzumab after adjuvant chemo significantly improves disease-free survival among women with HER2 positive breast cancer