Current Best Practice in Breast Cancer
|
SETTING |
ER+, Her2- |
ER+, Her2+ |
ER-, HER2+ |
TRIPLE NEGATIVE |
|---|---|---|---|---|
|
NEOADJUVANT |
Chemo in: •Inflammatory Breast Cancer. •Heavy nodal / borderline operable. •To allow Breast Conservation. •AI + CDK4/6 in inoperable cancers without distant mets. |
•All Tumours >2cm (regardless of nodal status) should be treated with anthracyclines-taxol regimes alongside Herceptin and Pertuzumab (Neosphere*). |
•All Tumours >2cm (regardless of nodal status) should be treated with taxol regimes alongside Herceptin and Pertuzumab (Neosphere*). • |
•All tumours >2cm (regardless of nodal and PDL1 status) should be treated with Carboplatin containing regimes and Pembro (Keynote522*). |
|
ADJUVANT |
•Endocrine Blockade in all. •Chemo in selected node Neg (Tailorex*) and Node Pos patients (Rxponder*). •RT and Bisphosphonates in selected patients. •Olaparib if BRCA+ and >4 LNs involved (Olympia*). •Abemaciclib in N2 or N1 if G3 or T3 (MonarchE*). Ribo (Natalee*). |
•Endocrine blockade for all. RT and Bisphosphonates in selected patients. •Kadcyla if residual disease post NACT (Katherine*) . •Herceptin / Pertuzumab if NO residual disease post NACT. •Chemo and anti-Her2 tx in selected patients that did not receive NACT (APT, Persephone, Aphinity, ExteNET*). |
•Kadcyla if residual disease post NACT (Katherine*) . •Herceptin / Pertuzumab if NO residual disease post NACT. •Chemo and anti-Her2 tx in selected patients that did not receive NACT (APT, Persephone, Aphinity*). |
•Pembro +: •Olaparib if BRCA+ and residual disease post NACT (Olympia*). •Capecitabine in BRCA- and residual disease post NACT (Createx*). •Capecitabine if no NACT and BRCA- (Sysucc*). •RT and Bisphosphonates in selected patients. |
|
METASTATIC |
•1st and 2nd line: AI + CDK4/6 inh (Monalessa2/3/7, Monarch2/3*). •Exemestane / everolimus (Bolero2*). •Alpelisib if PIK3CA+ (Bylieve*). •Parp Inh in BRCA+ (OlympiAD, Embraca*). •Fulvestrant / Oral SERDs in ESR1 mutants (Emerald*). •AKT+ Capivasertive (Capitello, FAKTION*). •Enhertu if Her2low (Destiny04/06*). •Govitecan (Tropics02*). Chemo. • |
•Docetaxel, Herceptin, Pertuzumab (Cleopatra*). •Enhertu (Destiny03*). •Kadcyla (Emilia*). •Tucatinib, Capecitabine, Herceptin (Her2Climb*). •Add endocrine blockade to above if compatible. •Abemaciclib / Fulvestrant / Herceptin (MonarcHER*). • |
•Docetaxel, Herceptin, Pertuzumab (Cleopatra*). •Enhertu (Destiny03*). •Kadcyla (Emilia*). •Tucatinib, Capecitabine, Herceptin (Her2Climb*). •Neratinib. |
•Immunotherapy / chemo if PDL1 + (Keynote355, Impassion130*). •Carbo alone or Carbo/ Taxol if PDL1-. •Govitecan (Ascent*). •Parp Inh in BRCA+ >3rd line (OlympiAD,Embraca*). •Enhertu if Her2low (Destiny04*). Chemo. |
* Registration Trial. NACT: Neoadjuvant chemotherapy. RT: Radiotherapy. LN: Lymph Nodes. Tx: Therapy.