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NCCN Guidelines for Patients



Breast Cancer – Metastatic (STAGE IV), Version 2.2017


Treatment guide

Hormone receptor–positive cancers

endocrine therapy. After chemotherapy, you may

receive endocrine therapy, which is often less toxic.


. Your ovaries are the main source of

estrogen and progesterone. To lower hormone levels,

ovarian ablation or suppression is advised. You

should also receive endocrine therapy for women in

postmenopause. These treatments stop the effect of

estrogen made from sources other than the ovaries.

If you haven’t had endocrine therapy in the past year,

a second option is to take a SERM.


. In your body, estrogen is made

in small amounts by the adrenal glands, liver, and

body fat. To reduce estrogen levels, an aromatase

inhibitor may be used. It is often the first treatment

received if you’ve had no endocrine therapy in the

past year. Other options are an antiestrogen and for

HER2-negative cancers, palbociclib or ribociclib with


If you took endocrine therapy in the past year, your

options depend on multiple factors. They depend on

what treatment you had before. They also depend

on if the metastatic cancer is being treated for the

first time or not. If the cancer progressed during

treatment, your options may include exemestane

with everolimus, palbociclib with fulvestrant if HER2-

negative cancer, and high-dose hormones.

Stopping endocrine therapy

. Endocrine therapy is

advised until one of two events occurs. Stop taking

endocrine therapy if there are no benefits during 3

back-to-back regimens. Stop if there’s cancer in your

internal organs that is causing symptoms. At this

point, chemotherapy may be given. Read


receptor–negative cancers

to learn more about


Men with breast cancer

One out of every 100 breast cancers occurs

in men. Men with breast cancer are treated

much like women. One important difference

is treatment with endocrine therapy. Your

options are the same as for women in

postmenopause. However, aromatase

inhibitors should be taken with a treatment

that stops the making of testosterone by your

testes. Aromatase inhibitors alone won’t stop

hormone-related cancer growth.