Endocrine Therapy for Hormone Receptor–Positive Metastatic Breast Cancer: American Society of Clinical Oncology Guideline

Abstract

Purpose To develop recommendations about endocrine therapy for women with hormone receptor (HR) –positive metastatic breast cancer (MBC). Methods The American Society of Clinical Oncology convened an Expert Panel to conduct a systematic review of evidence from 2008 through 2015 to create recommendations informed by that evidence. Outcomes of interest included sequencing of hormonal agents, hormonal agents compared with chemotherapy, targeted biologic therapy, and treatment of premenopausal women. This guideline puts forth recommendations for endocrine therapy as treatment for women with HR-positive MBC. Recommendations Sequential hormone therapy is the preferential treatment for most women with HR-positive MBC. Except in cases of immediately life-threatening disease, hormone therapy, alone or in combination, should be used as initial treatment. Patients whose tumors express any level of hormone receptors should be offered hormone therapy. Treatment recommendations should be based on type of adjuvant treatment, disease-free interval, and organ function. Tumor markers should not be the sole criteria for determining tumor progression; use of additional biomarkers remains experimental. Assessment of menopausal status is critical; ovarian suppression or ablation should be included in premenopausal women. For postmenopausal women, aromatase inhibitors (AIs) are the preferred first-line endocrine therapy, with or without the cyclin-dependent kinase inhibitor palbociclib. As second-line therapy, fulvestrant should be administered at 500 mg with a loading schedule and may be administered with palbociclib. The mammalian target of rapamycin inhibitor everolimus may be administered with exemestane to postmenopausal women with MBC whose disease progresses while receiving nonsteroidal AIs. Among patients with HR-positive, human epidermal growth factor receptor 2–positive MBC, human epidermal growth factor receptor 2–targeted therapy plus an AI can be effective for those who are not chemotherapy candidates.

Endocrine Therapeutic Strategies for Patients with Hormone Receptor-positive Advanced Breast Cancer

“…To manage neutropaenia in patients receiving this drug combination, it is recommended that blood counts should be monitored before the start of each new cycle as well as on day 14 of the first two cycles, with appropriate palbociclib dose delays and reductions. 39 Overall, these data show promising efficacy with fulvestrant plus palbociclib, with manageable adverse events.…”

Palbociclib in Combination With Hormone Therapy for Luminal Her2-Negative Metastatic Breast Cancer: New Highly Effective Strategy of Drug Treatment

“…Благодаря молекулярно-биологическим исследо-ваниям последнего десятилетия сформировалась кон-цепция восприятия РМЖ как гетерогенного заболева-ния, состоящего из нескольких подвариантов, различных по своему прогнозу, клиническому течению и чувствительности к проводимой терапии [7,8]. Ос-новой лекарственного лечения ЭР+HER2-мРМЖ является последовательная ГТ [9].…”

Cyclin-Dependent Kinase Inhibitor, Palbociclib – A New Drug for the Treatment of Metastatic Breast Cancer

“…• согласно рекомендациям Американского об-щества клинической онкологии (American Society of Clinical Oncology, ASCO) от 2016 г., больным метастатическим РМЖ (мРМЖ) ГТ назначают при любом уровне экспрессии ре-цепторов гормонов [4]; • согласно консенсусу Панели экспертов (St. Gallen, 2017), низкий уровень экспрессии ER ставит под сомнение эффективность ГТ и в таких случаях, по крайней мере пациен-ткам с операбельным РМЖ, рекомендуется включать в схему адъювантного лечения цито-статическую терапию [5]. Выбор адекватного лечения ER-положительного мРМЖ основывается на факторах, характеризующих опухоль и состояние организма пациентки.…”