Systemic Treatment of Patients with Metastatic Breast Cancer

A. In Basic settings, the recommendations presume that neither chemotherapy, nor targeted therapy or molecular testing are available.
Italics = medications on Essential Medicines List (EML) (not universally available in low-income and lower-middle-income countries [<50%])
Italics, Underlined = not on EML
B. Per the “Palliative Care in the Global Setting: ASCO Resource-Stratified Guideline" Recommendations: There should be a coordinated system where the palliative care needs of patients and families are identified and met at all levels, in collaboration with the team providing oncology care. The health care system should have trained personnel who are licensed to prescribe, deliver, and dispense opioids at all levels. Distance communication should be instituted at the national or regional level through oncology centers (or other tertiary care centers) to support those providing oncology care to patients in lower resource areas.
C. General: Palliative care needs should be addressed for all patients with cancer at presentation using appropriate screening, especially when disease-modifying interventions are not available.
D. Patients eligible for PARPi if they previously received chemotherapy for neoadjuvant, adjuvant, or metastatic disease.

* Palliative care may or may not include radiation therapy for symptom control.
** For patients who are pre-menopausal: can only receive aromatase inhibitors if accompanied by ovarian ablation or ovarian suppression