systemic therapy of breast cancer
treatment
Stage I–III (above)
Chemo
- Neoadjuvant: to conserve breast & evaluate Rx efficacy, equivalent OS as adjuvant (JCO 2008;26:778)
- Adjuvant: use anthracycline ± taxane. Nb, endocrine only for some ER/PR ⊕ based on oncotype Dx (see staging).
Triple negative
Immune
- Pembrolizumab (anti-PD-1 mAb) + chemo 1st-line for early stage (NEJM 2020;382:810) & PD-L1 ⊕ met dis. (Lancet 2020;396:1817)
- Ab-drug conjugate
- Sacituzumab govitecan: anti-trop-2 Ab linked to chemo ↑ PFS & OS in heavily pre-Rx’d metastatic disease (NEJM 2019;380:741)
BRCA
PARP inh
- Olaparib & talazoparib (NEJM 2017;377:523 & 2018;379:753)
DFS, disease-free survival; OS, overall survival; PFS, progression-free survival