Fast Five Quiz: Key Aspects of Metastatic Breast Cancer

Stefania Morganti, MD


December 15, 2022

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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