Skill Checkup: A 56-Year-Old Woman With a History of Breast Cancer and Pain in Her Ribs and Spine

Pavani Chalasani, MD, MPH


January 14, 2022

Preferred first-line systemic endocrine-based therapy options are category 1 recommendations (based on phase 3 clinical trial evidence) per National Comprehensive Cancer Network (NCCN) clinical practice guidelines. They include an aromatase inhibitor (ie, anastrozole, exemestane, or letrozole) in combination with a CDK4/6 inhibitor (ie, 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.

A HER2-receptor antagonist, with or without chemotherapy, is used only for HER2-positive breast cancer. According to the NCCN guidelines, most women with HER2-positive 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-positive breast cancer.

Cytotoxic chemotherapy, for example with a taxane, is still the mainstay of systemic treatment for advanced triple-negative disease. The antibody-drug conjugate sacituzumab govitecan has also been approved for triple-negative disease and has shown improved progression-free and overall survival compared with single-agent chemotherapy. Studies are also examining the use of other drug classes, including checkpoint inhibitors and agents that target the androgen receptor pathways.


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