ASCO Issues Guidelines on Hormonal Therapy for Metastatic Breast Cancer

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The American Society of Clinical Oncology (ASCO) has put out new guidelines on hormonal therapy treatment for women with hormone-receptor-positive metastatic breast cancer. Sequential hormone therapy is the preferred treatment for most women.

Sequential hormone therapy means a woman is treated with one hormonal therapy medicine until it stops working or she develops unacceptable side effects. Then she is treated with a different hormonal therapy medicine.

Metastatic breast cancer is breast cancer that has spread away from the breast area to other places in the body, such as the bones, liver, or brain.

The guidelines were published online on June 20, 2016 by the Journal of Clinical Oncology. Read the abstract of “Endocrine Therapy for Hormone Receptor-Positive Metastatic Breast Cancer: American Society of Clinical Oncology Guideline.”

ASCO is a national organization of oncologists and other cancer care providers. ASCO guidelines give doctors recommendations for treatments and testing that are supported by much credible research and experience.

Hope Rugo, M.D., clinical professor of medicine at the University of California, San Francisco Helen Diller Family Comprehensive Cancer Center and member of the Breastcancer.org Professional Advisory Board, is one of the experts who developed the guidelines.

The ASCO experts based the new guidelines on a review of research published between 2008 and 2015. Key recommendations are:

  • Hormonal therapy should be offered to women diagnosed with hormone-receptor-positive disease, no matter if the cancer is estrogen-receptor-positive or progesterone-receptor-positive.
  • Except in a few cases, hormonal therapy, alone or in combination, should be used as the first treatment for hormone-receptor-positive metastatic disease.
  • Treatment recommendations should be based on the type of treatments a woman had after surgery, how long she was disease-free (if the cancer is a recurrence), and her general health.
  • A woman should take hormonal therapy until the cancer progresses.
  • Combining hormonal therapy with chemotherapy is not recommended.
  • As there is no cure for metastatic breast cancer yet, doctors should encourage eligible women to enroll in a clinical trial that is appropriate for their situation.
  • Postmenopausal women should be offered an aromatase inhibitor as the first hormonal therapy.
  • Combination treatment with an aromatase inhibitor and Faslodex (chemical name: fulvestrant), an estrogen receptor downregulator, can be used to treat women who haven’t taken hormonal therapy before.
  • Premenopausal women should be offered medicines to suppress ovarian function or surgery to remove the ovaries along with hormonal therapy.
  • An aromatase inhibitor and the targeted therapy Ibrance (chemical name: palbociclib) may be offered to women who haven’t been treated for breast cancer before.
  • If the cancer grows during treatment, a woman may be offered Afinitor (chemical name: everolimus) along with the aromatase inhibitor Aromasin (chemical name: exemestane).
  • If the cancer grows during treatment with an aromatase inhibitor, a woman may be offered Faslodex and Ibrance.
  • If a woman is diagnosed with metastatic hormone-receptor-positive disease that is also HER2-positive, she may be offered a medicine that targets HER2 receptors, such as Herceptin (chemical name: trastuzumab) or Kadcyla (chemical name: T-DM1 or ado-trastuzumab emtansine), if chemotherapy isn’t immediately recommended.
  • Tumor markers or circulating tumor cells should not be the only way doctors determine if the cancer is progressing. Imaging, clinical exams, and new symptoms should also be considered.
  • Doctors should recognize and acknowledge the special issues faced by premenopausal women diagnosed with metastatic breast cancer, including loss of fertility.

If you’ve been diagnosed with metastatic hormone-receptor-positive breast cancer, it’s good to know that you have several treatment options available. If one treatment stops working, there are others you can try. If you’re willing to participate in a clinical trial, you may have even more options available. Together, you and your doctor can determine the best treatments for you.



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