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28

NCCN Guidelines for Patients

®

:

Breast Cancer – Metastatic (STAGE IV), Version 2.2017

3

Treatment guide

Hormone receptor–positive cancers

Treatment options

Guide 3

lists the treatment options for hormone

receptor–positive breast cancer. Options are based

on if you received endocrine therapy in the past year

or not. They are also based on menopausal status.

Menopause is the point in time when you won’t have

another menstrual period again. When a woman

hasn’t had a period in one or more years, she’s often

considered in postmenopause. If you get menstrual

periods, you are in premenopause.

If you don’t get periods, blood tests may be needed

to confirm your menopausal status. The amount

of estrogen or FSH (

f

ollicle-

s

timulating

h

ormone)

in your blood will be measured. Sometimes, these

blood tests can’t be done until you’ve been off certain

medicines for some time.

Chemotherapy first

. Sometimes, breast cancer can

spread quickly within internal organs. Your internal

organs include your liver and lungs. In this case, you

may first receive chemotherapy to quickly control

the cancer growth. Chemotherapy works faster than

Guide 3. Treatment options for hormone-related growth

Prior endocrine therapy

What are the options?

None in past year

ª

• For fast-spreading cancers, maybe chemotherapy first

• If in premenopause:

◦◦ Ovarian ablation or suppression + one therapy listed for

postmenopause

◦◦ SERM alone (tamoxifen or toremifene)

• If in postmenopause:

◦◦ Aromatase inhibitor (anastrozole, letrozole, or exemestane)

◦◦ Antiestrogen (tamoxifen, toremifene, or fulvestrant)

◦◦ Palbociclib + letrozole if HER2 negative

◦◦ Ribociclib + letrozole if HER2 negative

Took in past year

ª

• For fast-spreading cancers, maybe chemotherapy first

• If in premenopause:

◦◦ Ovarian ablation or suppression + one therapy listed for

postmenopause

• If in postmenopause:

◦◦ Aromatase inhibitor (anastrozole, letrozole, or exemestane)

◦◦ Antiestrogen (tamoxifen, toremifene, or fulvestrant)

◦◦ Palbociclib + letrozole if HER2 negative

◦◦ Exemestane + everolimus

◦◦ Palbociclib + fulvestrant if HER2 negative

◦◦ Hormones (ethinyl estradiol, fluoxymesterone, or megestrol acetate)