Metastatic Breast Cancer

Prognostic factors in metastatic breast CA

  • Tumour biology ( grade/ ER status/ HER-2 status )
  • Performance status
  • Cancer related symptoms
  • Site of recurrence
  • Bone vs Visceral
  • Number of sites
  • Prior adjuvant therapy
  • Dis-free interval
  • Prior therapy for metastatic disease
  • AND response/ duration with prior therapy

Treatments:

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Premenopausal Women

  • On tamoxifen
    • Oophorectomy + AI
  • Not on tamoxifen
    • Oophorectomy + Tamoxifen
      • Combination improves survival comparing to each alone
  • Tamoxifen —> 50% response rate

Post-menopausal Women

  • Tamoxifen
  • AI
  • Fulvestrant
  • Progestational Agent
  • Pharmacologic endocrine therapy
    • 1st line treatment —> 8-12m tumour control
    • 2nd line treatment —> 4-6m

Indication for chemotherapy:

  • symptomatic tumour progression
  • pending visceral crisis
  • resistance to multiple endocrine therapies
  • Extensive visceral metastasis or profound symtoms
    • Induction chemo —> endocrine therapy