The ongoing evaluation of patients during therapy (including timing of imaging and the selection of imaging modality) should be individualized according to patient and provider preferences. Further discussion on the monitoring of patients with metastatic breast cancer is covered separately.
Careful assessment for response to treatment requires serial clinical examination, repeat lab evaluation (including tumor markers), and radiographic imaging. Although there is no standard schedule for evaluation during treatment, a reasonable approach would be as follows:
History and physical exam prior to the start of each treatment cycle (ie, day one of a new 21- or 28-day treatment cycle).
Repeat imaging studies (using the same imaging modality throughout) after completion of two cycles of therapy (ie, after cycle two, cycle four, etc).
Serial assay for serum tumor markers (eg, cancer antigen [CA] 15-3, CA 27.29, and/or carcinoembryonic antigen [CEA]) if they were elevated at baseline. If performed, we typically reevaluate them at the beginning of each treatment cycle.