What is the role of endocrine therapy in the treatment of postmenopausal women with stage IV breast cancer?

Updated: Apr 23, 2020
  • Author: Joseph A Sparano, MD; Chief Editor: John V Kiluk, MD, FACS  more...
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Answer

Answer

Treatment with a single endocrine agent is usually continued until disease progression. Considerations are as follows:

  • AIs have been shown to be more effective than tamoxifen for adjuvant therapy and metastatic disease.

  • Patients who experience relapse or have progressive disease on tamoxifen may be switched to an AI.

  • Patients who experience relapse or progress while receiving a nonsteroidal AI (eg, anastrozole or letrozole) may be changed to a steroidal AI (eg, exemestane) or a selective ER-downregulator (eg, fulvestrant).

  • Fulvestrant regimen is 500 mg IM on days on days 1, 15, 29 and once monthly thereafter or in combination with palbociclib 125 mg PO once daily days 1-21. [32, 33, 34]

  • Optionally, consider the androgenic agent fluoxymesterone 10 mg PO BID [35]  or  the progestational agent megestrol acetate 40 mg PO QID [36]  or  estradiol 2 mg PO BID. [37]

  • Systemic chemotherapy should be reserved for patients with hormone-insensitive disease or for patients with symptomatic hormone-sensitive disease in whom all hormone therapy options have failed or who are moderately to severely symptomatic and in urgent need of symptom palliation.

  • The options for cytotoxic-containing chemotherapy include single-agent therapy and combination cytotoxic therapy.


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