Info

🌱來自: metastatic breast cancer

Hormone-receptor positive (HER2 negative)-of-metastatic breast cancer

Tx paradigm: Serial endocrine therapy ± targeted agents until failure → chemo (start w/ chemo if visceral crisis or rapid POD)

Endocrine therapy

1st line

• ET + CDK4_6i (AI + palbociclib, abemaciclib, ribociclib all w/ similar PFS benefit (HR 0.48 to 0.55), OS maturing.
• See Table below for tox
  • (PALOMA-2, NEJM 2016;375:1925; MONALEESA-2, Ann Oncol 2018;29:1541; MONARCH 3, JCO 2019;5:5)
• If premenopausal, OFS + AI + CDK4/6.
  • Ribociclib vs. placebo + ET (tam/AI+OFS) showed ↑ PFS, OS (MONALEESA-7, Lancet 2018;19:904)
• Fulvestrant + ribociclib (MONALEESA-3, NEJM 2020;382:514)
  • (especially if met <12 mos on adj. AI) vs. fulvestrant + AI vs. single agent ET

2nd line or later

• Fulvestrant + CDK4/6i (if not received 1st line)
  • PALOMA-3, NEJM 2018;379:1926; 多5個月
  • MONALEESA-3, NEJM 2020;382:514; 29:1541; as 1L or 2L
  • MONARCH 2, JAMA Onc 2019;6:116
• If PIK3CA mut:
  • Fulvestrant + alpelisib-↑ PFS (SOLAR1, NEJM 2019;380:1929)
  • Requires monitoring for hyperglycemia, stomatitis, rash, diarrhea
• Everolimus + exemestane:
  • ↑ PFS (BOLERO-2, NEJM 2012;366:520)
• Abemaciclib single agent:
  • Clinical benefit rate of 42%
  • MONARCH-1, CCR 2017;23:5218
• Single agent ET in case of elderly or poor KPS pts

Chemo (same paradigm as in TNBC section below), but favor cape if gradual pace of progression

• Triple negative disease

Therapies under development

• Oral SERD (multiple in development),
• PI3K delta-selective inhibitors,
• AKTi,
• CDK2/4/6 inhibitor

Siblings

• Workup-of-metastatic breast cancer
• General management principles-of-metastatic breast cancer
• Hormone-receptor positive (HER2 negative)-of-metastatic breast cancer
• HER2 positive-of-metastatic breast cancer
• Triple negative disease
• Bone metastasis