Preferred first-line systemic endocrine-based therapy options, which are category 1 recommendations (based on phase 3 clinical trial evidence) per National Comprehensive Cancer Network (NCCN) guidelines, include an aromatase inhibitor (anastrozole, exemestane, or letrozole) in combination with a cyclin-dependent kinase 4/6 (CDK4/6) inhibitor (palbociclib, ribociclib, or abemaciclib); fulvestrant with or without a nonsteroidal aromatase inhibitor (ie, anastrozole or letrozole); or fulvestrant in combination with a CDK4/6 inhibitor.
Given that patients with HR+/HER2- metastatic breast cancer will ultimately have disease progression after first-line therapy, second-line systemic endocrine-based therapy options must be considered. Preferred second-line systemic endocrine-based therapy options, which are category 1 recommendations per NCCN guidelines, include fulvestrant in combination with a CDK4/6 inhibitor (if a CDK4/6 inhibitor was not utilized in the first-line setting) or fulvestrant in combination with alpelisib (only in patients with PIK3CA mutations). Other preferred second-line systemic endocrine-based therapy options include everolimus in combination with exemestane, tamoxifen, or fulvestrant; fulvestrant monotherapy; nonsteroidal aromatase inhibitor monotherapy; or selective estrogen receptor modulator monotherapy.
A HER2-receptor antagonist, with or without chemotherapy, is used only for HER2+ breast cancer. Most women with HER2+ breast cancer will receive one or more chemotherapy drugs plus trastuzumab, the anti–HER2-receptor antagonist. Many studies have shown that these treatments dramatically improve survival for women with HER2+ breast cancer (SEER).
Learn more about medications for metastatic breast cancer.
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Cite this: Winston W. Tan. Fast Five Quiz: HR-Positive/HER2-Negative Breast Cancer - Medscape - Sep 14, 2021.