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34

NCCN Guidelines for Patients

®

:

Breast Cancer – Metastatic (STAGE IV), Version 2.2017

Treatment options

Chemotherapy is an option for all hormone receptor–

negative cancers. Very rarely, endocrine therapy is

received. It may be tried for cancer that has spread

to the bones only, soft tissue only, or internal organs

without causing symptoms. Examples of soft tissue

include muscle, fat, and lymph nodes. Examples of

internal organs include the liver, brain, and lungs.

Chemotherapy and targeted therapy

options

depend on HER2 status.

Guide 6

lists the treatment

options for HER2-negative cancers. These cancers

are also called triple-negative cancers because

they also lack hormone receptors. Single agents

are grouped into preferred and other agents. These

groups are based on how well the drug works, side

effects, and treatment schedules. Combination

regimens are also listed. They are not better than

single agents and have worse side effects.

Guide 7

lists the treatment options for HER2-

positive cancers. There are two preferred options

for treating metastatic cancer for the first time. They

consist of both HER2 antibodies (trastuzumab and

3

Treatment guide

Hormone receptor–negative cancers

Guide 6. Options for HER2-negative cancers

Preferred single agents

Length of a cycle

Other single agents

Length of a cycle

Doxorubicin

21 days

Cyclophosphamide

28 days

Pegylated liposomal doxorubicin 28 days

Carboplatin

21 to 28 days

Paclitaxel

21 days

Docetaxel

21 or 56 days

Capecitabine

21 days

Albumin-bound paclitaxel

21 or 28 days

Gemcitabine

28 days

Cisplatin

21 days

Vinorelbine

7 days

Epirubicin

21 days

Eribulin

21 days

Ixabepilone

21 days

Combination regimens

Length of a cycle

CAF/FAC (cyclophosphamide/doxorubicin/fluorouracil)

21 (FAC) or 28 (CAF) days

FEC (fluorouracil/epirubicin/cyclophosphamide)

28 days

AC (doxorubicin/cyclophosphamide)

21 days

EC (epirubicin/cyclophosphamide)

21 days

CMF (cyclophosphamide/methotrexate/fluorouracil)

28 days

Docetaxel/capecitabine

21 days

GT (gemcitabine/paclitaxel)

21 days

Gemcitabine/carboplatin

21 days

Paclitaxel/bevacizumab

28 days