Treatment with a CDK4/6 inhibitor in combination with an endocrine agent is the standard first-line therapy for eligible patients with metastatic hormone receptor–positive breast cancer and is generally continued until disease progression or unacceptable toxicity. Considerations are as follows:
Postmenopausal women who experience relapse of breast cancer while receiving adjuvant selective estrogen receptor modulator (eg, tamoxifen) may be switched to an AI in combination with CDK4/6 inhibitor as first-line therapy.
The combination of an AI plus a CDK4/6 inhibitor should be offered to postmenopausal patients (and to premenopausal patients, combined with chemical ovarian function suppression) with treatment-naive hormone receptor–positive metastatic breast cancer.
Fulvestrant and a CDK4/6 inhibitor should be offered to patients with progressive disease during treatment with AIs (or who develop recurrence within 1 year of adjuvant AI therapy) with or without one line of prior chemotherapy for metastatic disease, or as first-line therapy.
Fulvestrant is administered intramuscularly, 500 mg, on days 1, 15, and 29 and once monthly thereafter, either alone or in combination with targeted agents.
Systemic chemotherapy should be reserved for patients with endocrine-resistant disease or those in visceral crisis.
In the metastatic setting, single-agent chemotherapy is preferred.
Learn more about endocrine regimens that may be offered as first-line therapy for postmenopausal women with endocrine-sensitive metastatic breast cancer.
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Cite this: Stefania Morganti. Fast Five Quiz: Key Aspects of Metastatic Breast Cancer - Medscape - Dec 15, 2022.
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