Summary and recommendations | ПРЕЦИЗИОННАЯ ОНКОЛОГИЯ

Summary and recommendations

UpToDate (2015)

  • Despite the gains in early detection, up to five% of women diagnosed with breast cancer have metastatic disease at the time of first presentation. In addition, up to 30% of women with early-stage, non-metastatic breast cancer at diagnosis will develop distant metastatic disease. Although metastatic breast cancer is unlikely to be cured, meaningful improvements in survival have been seen, coincident with the introduction of newer systemic therapies.
  • The goals of treatment of metastatic breast cancer are to prolong survival and improve quality of life by reducing cancer-related symptoms. In order to achieve these goals an individualized approach is needed since no one strategy can be applied for all women.
  • For patients with estrogen-receptor (ER), progesterone-receptor (PR), and Human Epidermal Growth Factor Receptor 2 (HER2)-negative (triple-negative) breast cancer, chemotherapy is the only option for treatment of metastatic breast cancer because they are not candidates for endocrine or HER2-directed therapy.
  • For most patients with hormone receptor-positive disease, endocrine therapy is the preferred treatment for metastatic breast cancer. However, we suggest chemotherapy if they are symptomatic from their disease (Grade 2C). This includes patients who experience rapid disease progression and those with a large tumor burden involving visceral organs.
  • For patients in whom chemotherapy is recommended, the choice of regimen (ie, single-agent or a combination) and selection of a specific therapy depends on multiple factors, including the tumor burden (both in tumor volume and the presence of disease-related symptoms), general health status, prior treatments and toxicities, and patient preferences. These factors can help in the formulation of an individualized treatment plan in the first- or later-line setting.
  • For patients with a limited tumor burden and/or limited or minimal cancer-related symptoms, we suggest single-agent chemotherapy administered sequentially rather than combination chemotherapy (Grade 2B).
  • For select patients with symptomatic disease due to the location of specific metastatic lesions (eg, right upper quadrant pain due to expanding liver metastases, or dyspnea related to diffuse lung metastases) and a large tumor burden, we suggest a combination regimen rather than a single-agent (Grade 2B). Combination therapy results in a greater likelihood of a response compared with single-agent therapy, which may be of a sufficient benefit to justify the risks of treatment.
  • Careful assessment for response to treatment requires serial clinical examination, repeat lab evaluation (including tumor markers), and radiographic imaging.
  • Unlike in the adjuvant setting, there is no predetermined duration of treatment. For the young patient who is responding to treatment, we suggest continuation of chemotherapy beyond best response (Grade 2B). However, for patients who experience side effects to treatment or prefer not to continue treatment for whatever reason, discontinuation of treatment is reasonable.
  • Some criteria that we use to define treatment failure include any of the following: clinical deterioration during treatment (ie, increasing disease-related symptoms, intolerable treatment toxicity, a decline in performance status), appearance of new metastases, and increasing size of previously documented metastatic lesions.

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