Ask the Experts - First-line hormonal therapy in metastatic breast...
Ask the Experts - First-line hormonal therapy in metastatic breast...
The case is a woman with metastatic breast cancer, diagnosed 13 years after treatment with adjuvant chemotherapy, for stage II breast cancer. She has metastatic disease in her bones, and is receiving palliative radiation therapy and tamoxifen. For how long does one continue first-line hormonal therapy in patients with metastatic breast cancer?
Dr. Marcos Levin
First-line hormonal therapy for patients with ER positive metastatic breast cancer should be continued until the time of disease progression . Many patients will have excellent responses to hormonal agents for metastatic breast cancer. On average, such patients will have 12 months or so of good clinical control, and many patients will do well for even longer periods of time. The decision to change therapies rests on clinical assessment of the patient. If she has progression of her disease--as seen on radiological studies or as evidenced by deteriorating clinical status--then it is reasonable to switch therapies. Women with ER positive tumors who have long disease free intervals and/or have clinical response or marked disease stabilization with first-line hormonal therapy are candidates for second-line or even third-line hormonal agents before using chemotherapy. Finally, there are data suggesting that use of bisphosphonates may help to reduce bone complications in women with metastatic breast cancer to the bone. Such therapy should be considered for patients such as this one.
The case is a woman with metastatic breast cancer, diagnosed 13 years after treatment with adjuvant chemotherapy, for stage II breast cancer. She has metastatic disease in her bones, and is receiving palliative radiation therapy and tamoxifen. For how long does one continue first-line hormonal therapy in patients with metastatic breast cancer?
Dr. Marcos Levin
First-line hormonal therapy for patients with ER positive metastatic breast cancer should be continued until the time of disease progression . Many patients will have excellent responses to hormonal agents for metastatic breast cancer. On average, such patients will have 12 months or so of good clinical control, and many patients will do well for even longer periods of time. The decision to change therapies rests on clinical assessment of the patient. If she has progression of her disease--as seen on radiological studies or as evidenced by deteriorating clinical status--then it is reasonable to switch therapies. Women with ER positive tumors who have long disease free intervals and/or have clinical response or marked disease stabilization with first-line hormonal therapy are candidates for second-line or even third-line hormonal agents before using chemotherapy. Finally, there are data suggesting that use of bisphosphonates may help to reduce bone complications in women with metastatic breast cancer to the bone. Such therapy should be considered for patients such as this one.