Systemic Treatment of Patients With Metastatic Breast Cancer
Key Points
Key Points
- Palliative care needs should be addressed for all patients at presentation of metastatic breast cancer (MBC), including situations in which no antineoplastic interventions are accessible.
- Patients who are premenopausal can receive aromatase inhibitors only if accompanied by ovarian ablation or ovarian suppression.
- Clinicians should recommend treatment according to pathological and biomarker features when quality (following established guidelines) testing results are available.
- Cases should be discussed using a multidisciplinary approach with the core team including the surgeon, pathologist, oncologist, and radiation oncologist.
Table 1. Framework of Resource Stratification
| Setting | |
|---|---|
| Basic | Core resources or fundamental services that are absolutely necessary for any public health/primary health care system to function; basic-level services typically are applied in a single clinical interaction. Vaccination is feasible for highest need populations. |
| Limited | Second-tier resources or services that are intended to produce major improvements in outcome such as incidence and cost-effectiveness and are attainable with limited financial means and modest infrastructure; limited-level services may involve single or multiple interactions. Universal public health interventions feasible for greater percentage of population than primary target group. |
| Enhanced | Third-tier resources or services that are optional but important; enhanced-level resources should produce further improvements in outcome and increase the number and quality of options and individual choice. (Perhaps ability to track patients and links to registries). |
| Maximal | May use high-resource settings’ guidelines. High-level/state-of-the-art resources or services that may be used/available in some high-resource countries and/or may be recommended by high-resource setting guidelines that do not adapt to resource constraints but that nonetheless should be considered a lower priority than those resources or services listed in the other categories on the basis of extreme cost and/or impracticality for broad use in a resource-limited environment. |
Treatment
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...Positive, HER2-Negative...
1.1....
..., palliative,* and best supportive care should...
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1.1.2
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1.1.4
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1.1.5
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2.1....
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Table 5. Maximal Setting: Third-line Options...
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