Management Options for Metastatic Breast Caner

The CDK 4/6 inhibitors:
- Are a class of oral drugs:
  - That have been approved for HR+, HER2-negative metastatic breast cancer in the first-line setting or after progression on prior aromatase inhibitor
In the MONALEESA-3 trial:
- Ribociclib in combination with fulvestrant:
  - Showed progression-free survival (20.5 months vs. 12.8 months) and overall survival benefit over fulvestrant alone in HR+, HER2-negative metastatic breast cancer:
    - That was either treatment naïve or had up to one prior line of endocrine therapy
Everolimus:
- Is an mTOR inhibitor with evidence of benefit in the metastatic setting after prior aromatase inhibitor
- However it is FDA-approved in combination with exemestane per the BOLERO-2 trial
Chemotherapy is an effective treatment strategy in metastatic disease of the breast of any subtype:
- But is not first line treatment in patients with limited disease asymptomatic
In the metastatic setting:
- Radiation is generally pursued to palliate symptoms or control isolated disease that is not responding to systemic therapy

References

1. Slamon DJ, Neven P, Chia S, Fasching PA1, De Laurentiis M1, Im SA, et al. Phase III randomized study of ribociclib and fulvestrant in hormone receptor-positive, human epidermal growth factor receptor 2-negative advanced breast cancer: MONALEESA-3. J Clin Oncol. 2018;36(24):2465-2472.

2. Slamon DJ NP, Chia S, et al. Overall survival (OS) results of the phase III MONALEESA-3 trial of postmenopausal patients (pts) with hormone receptor-positive (HR+), human epidermal growth factor 2-negative (HER2-) advanced breast cancer (ABC) treated with fulvestrant (FUL) + ribociclib (rib). Paper presented at: ESMO; September 27 to October 1, 2019, 2019; Barcelona, Spain.

3. Baselga J, Campone M, Piccart M, Burris HA 3rd, Rugo HS, Sahmoud T, et al. Everolimus in postmenopausal hormone-receptor–positive advanced breast cancer. N Engl J Med. 2011;366(6):520-529