Metastatic Breast Cancer First Line Management

  • Paclitaxel monotherapy:
    • It is recommended as one of the first lines of therapy for metastatic triple negative breast cancer:
      • Safety data are reported for its use in the elderly
    • In addition, because it is administered weekly:
      • It is easy to reduce the dose in the presence of toxicities
    • Local therapy:
      • Is not indicated for most patients with distant metastatic disease in the absence of symptoms
    • HER2 therapies:
      • Are not indicated in the treatment of HER2 negative tumors
    • Dose-dense doxorubicin and cyclophosphamide is often part of the regimen for early-stage triple negative breast cancer:
      • Not metastatic disease
    • Testing for PDL1 to see if she is a candidate for immunotherapy with chemotherapy would be indicated if the patient is interested in this treatment option

References

1. Li X, Kwon H. Efficacy and Safety of Nanoparticle Albumin-Bound Paclitaxel in Elderly Patients with Metastatic Breast Cancer: A Meta-Analysis. J Clin Med. 2019 Oct 15;8(10).

2. Biganzoli L, Wildiers H, Oakman C, Marotti L, Loibl S, Kunkler I, et al. Management of elderly patients with breast cancer: updated recommendations of the International Society of Geriatric Oncology (SIOG) and European Society of Breast Cancer Specialists (EUSOMA). Lancet Oncol. 2012;13(4):e148-e160.

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