Fast Five Quiz: Key Aspects of Metastatic Breast Cancer

Elwyn C. Cabebe, MD


August 10, 2020

Treatment with a single endocrine agent is usually continued until disease progression. Considerations are as follows:

  • AIs have been shown to be more effective than tamoxifen for adjuvant therapy and metastatic disease.

  • Patients who have relapse or have progressive disease on tamoxifen may be switched to an AI.

  • Patients who have relapse or progression of disease while receiving a nonsteroidal AI (eg, anastrozole or letrozole) may be changed to a steroidal AI (eg, exemestane) or a selective ER-downregulator (eg, fulvestrant).

  • The fulvestrant regimen is 500 mg intramuscularly on days on days 1, 15, and 29 and once monthly thereafter or in combination with palbociclib (125 mg orally once daily, days 1-21).

  • Optionally, consider the androgenic agent fluoxymesterone (10 mg orally twice daily) or the progestational agent megestrol acetate (40 mg orally four times daily) or estradiol (2 mg orally twice daily).

  • Systemic chemotherapy should be reserved for patients with hormone-insensitive disease or those with symptomatic hormone-sensitive disease who have not responded to any hormone therapy options or who are moderately to severely symptomatic and in urgent need of symptom palliation.

  • The options for cytotoxic-containing chemotherapy include single-agent therapy and combination cytotoxic therapy.

Learn more about endocrine therapy in postmenopausal women with metastatic breast cancer.


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