Info

🌱 來自: Clinical Pathway-of-breast cancer

adjuvant endocrine therapy for breast cancer

definition of menopause

Stage I

• T1ab (a.k.a. < 1cm)
  • Premenopause Tamoxifen x 5 years
  • Postmenopause AI x 5 years
• T1c (a.k.a. > 1cm)
  • Premenopause Tamoxifen x 5 years ± OFS
    • 如果年紀小於35，則考慮OFS plus AI, Why?
    • Suppression of Ovarian Function Trial (SOFT) 9成15 對 9成35的 → 歐斯
    • Tamoxifen and Exemestane Trial (TEXT) 歐斯 💥 沒有差
    • 可顯著降低 ↓ 復發風險，但會增加 ↑ 毒性。
  • Considered in high risk group, particularly those warranting chemotherapy
  • Postmenopause AI x 5 years

Stage II

• N(-) (a.k.a. > 2cm)

  • Premenopause OFS and AI/tamoxifen
  • Postmenopause AI x 5 years

• N(+) (a.k.a. N1)

  • Premenopause Extended therapy, OFS and AI/tamoxifen
  • Postmenopause Extended therapy

Stage III

• Extended therapy, OFS and AI/tamoxifen in premonopause
  • 10 years or 7~8 years

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HIGHER-RISK, HORMONE RECEPTOR-POSITIVE, HER2-NEGATIVE CANCERS

Breast Identification of higher-risk patients and approach Ovarian suppression plus endocrine therapy Methods of suppression Efficacy in high-risk disease Rationale for OFS Rationale for AI over tamoxifen, in combination with OFS Toxicity Sequencing ovarian suppression with other systemic therapies Addition of targeted therapies for select, high-risk cancers Addition of CDK 4/6 inhibitor to adjuvant endocrine therapy in high-risk disease Olaparib for select high risk, BRCA-mutated cancers LOW- TO AVERAGE-RISK, HORMONE RECEPTOR-POSITIVE, HER2-NEGATIVE CANCERS Preference for tamoxifen Tamoxifen versus OFS plus endocrine therapy Tamoxifen versus placebo Transitioning from tamoxifen to an AI after menopause Risk of ovarian function reactivation on an AI HORMONE RECEPTOR-POSITIVE, HER2-POSITIVE CANCERS DURATION OF ENDOCRINE THERAPY SPECIAL CONSIDERATIONS Patients who became amenorrheic during chemotherapy Importance of contraception Fertility preservation