Optimizing care for younger women with hormone receptor-positive, HER2-negative metastatic breast cancer

Richard de Boer; Rina Hui; Elgene Lim; Belinda Yeo; Nicholas Zdenkowski

doi:10.1111/ajco.13461

Optimizing care for younger women with hormone receptor-positive, HER2-negative metastatic breast cancer

Asia Pac J Clin Oncol. 2020 Nov:16 Suppl 5:3-14. doi: 10.1111/ajco.13461.

Authors

Richard de Boer^{1

2}, Rina Hui^{3

4}, Elgene Lim^{5

6}, Belinda Yeo^{7

8}, Nicholas Zdenkowski^{9

10

11}

Affiliations

¹ Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
² Epworth-Freemasons Private Hospital, Melbourne, Victoria, Australia.
³ University of Sydney, Camperdown, Sydney, New South Wales, Australia.
⁴ Westmead Hospital, Westmead, Sydney, New South Wales, Australia.
⁵ St. Vincent's Clinical School, University of New South Wales, Darlinghurst, Sydney, New South Wales, Australia.
⁶ Garvan Institute of Medical Research, Darlinghurst, Sydney, New South Wales, Australia.
⁷ Austin Health, Heidelberg, Melbourne, Victoria, Australia.
⁸ Olivia Newton-John Cancer Research Institute, Heidelberg, Melbourne, Victoria, Australia.
⁹ University of Newcastle, Newcastle, New South Wales, Australia.
¹⁰ Lake Macquarie Private Hospital, Gateshead, New South Wales, Australia.
¹¹ Breast Cancer Trials, Newcastle, New South Wales, Australia.

PMID: 33137857
DOI: 10.1111/ajco.13461

Abstract

Treatment strategies for hormone receptor-positive (HR⁺ ), human epidermal growth factor receptor 2-negative (HER2^- ) metastatic breast cancer in young women (<40 years at diagnosis) have traditionally been extrapolated from data obtained from trials conducted either exclusively or predominantly in the postmenopausal setting. These young patients are usually treated with ovarian function suppression (OFS) + endocrine therapy (ET) ± targeted therapy, except if there is a concern about endocrine resistance or a need to gain rapid disease control due to the onset of visceral crisis. This review examines evidence that supports the use of a cyclin-dependent kinase 4/6 inhibitor, in combination with OFS and ET, when treating premenopausal or perimenopausal women with HR⁺ /HER2^- metastatic breast cancer. This includes data from the MONALEESA-7 study (treating only premenopausal/perimenopausal women in the first-line setting), and the results of subgroup analyses from the PALOMA-3 and MONARCH-2 trials. We also consider a number of age-specific challenges that younger breast cancer patients can face, highlighting the importance of a multidisciplinary approach to ongoing care.

Keywords: CDK4/6 inhibitor; HER2-negative; endocrine therapy; hormone receptor-positive; metastatic breast cancer; psychosocial; supportive care; younger women.

MeSH terms

Adult
Breast Neoplasms / drug therapy*
Breast Neoplasms / pathology
Female
Humans
Receptors, Estrogen / therapeutic use*

Substances

Receptors, Estrogen