I. Endocrine therapy for advanced breast cancer.
(1) Indications for preferred endocrine therapy.
1. The patient is older than 35 years;
2.Disease free survival > 2 years;
3. Only bone and soft tissue metastases are present;
4, or the presence of asymptomatic visceral metastases;
5, ER and/or PR positive.
(2) Drug selection and precautions.
1. Select appropriate endocrine therapy drugs according to the patient’s menstrual status. Generally, premenopausal patients are given priority to triamcinolone acetonide, which can also be combined with drugs or surgical debulking. For postmenopausal patients, the third generation aromatase inhibitors are preferred. Patients who have reached menopause through drugs or surgery can also choose aromatase inhibitors.
2. Patients in whom triamcinolone acetonide and aromatase inhibitors fail may consider switching to chemotherapy or to other endocrine drugs, such as progesterone or toremifene.
Second, adjuvant endocrine therapy.
(1) Indications: Hormone receptor (ER and/or PR) positive early stage breast cancer
(2) Drug selection and precautions.
1.Adjuvant endocrine therapy for pre-menopausal patients is preferred to triamcinolone acetonide;
2.Patients with high risk of recurrence before menopause can be combined with ovarian suppression/excision;
3. During triamcinolone acetonide treatment, if the patient is already menopausal, he/she can switch to an aromatase inhibitor;
4.Postmenopausal patients are preferred to third-generation aromatase inhibitors, which are recommended for initiation;
5.Postmenopausal patients who cannot tolerate aromatase inhibitors can still choose triamcinolone acetonide;
6. The treatment period of postoperative adjuvant endocrine therapy is 5 years;
7. For patients with high risk factors for recurrence, the duration of endocrine therapy can be extended, and the extended dosing is only for third-generation aromatase inhibitors. Develop an individualized treatment plan;
8. Adjuvant endocrine therapy is not recommended for patients with negative ER and PR.