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Recommendations to individuals should be based on the risks, the absolute benefits and harms of treatment, and their personal preference. These factors should be discussed with the woman. Women receiving endocrine therapy should be reviewed regularly and monitored for adverse events by clinicians familiar with endocrine therapy.
| RECOMMENDATIONS | LEVEL OF EVIDENCE20 | REFERENCE |
|---|---|---|
| In women with hormone receptor-positive advanced breast cancer: | ||
| Endocrine therapy is recommended in preference to chemotherapy except in the presence of rapidly progressive visceral disease | I | Cochrane 20034 |
| Information about the treatment should be discussed with the patient. The patient should be adequately prepared for the treatment | I | NBCC* & NCCI22 |
| In pre-menopausal women with hormone receptor-positive advanced breast cancer: | ||
| Tamoxifen combined with luteinising hormone-releasing hormone (LH-RH) agonist is recommended in favour of a LH-RH agonist alone | I | Klijn 20012 |
| If commencing treatment with tamoxifen alone, consideration should be given to adding a LH-RH agonist, if response is not optimal | III | Klijn 20005 |
| Optimal dose and schedule of administration | ||
| Recommended doses and schedule are: Tamoxifen 20mg/day Goserelin 3.6mg subcutaneously monthly |
Therapeutic Goods Administration23 | |
| In post-menopausal women with hormone receptor-positive advanced breast cancer: | ||
| Aromatase inhibitors with trastuzumab are recommended for the treatment of women with HER2-positive hormone dependent advanced breast cancer in preference to aromatase inhibitors alone | II | NBCC21 * |
| First-line treatment | ||
| Third generation aromatase inhibitors are recommended in preference to tamoxifen | I | NBOCC3 * |
|
Second-line treatment (following progression on tamoxifen) | ||
| Third generation aromatase inhibitors are recommended in preference to progestins | I | NBOCC3 * |
| Optimal dose, schedule and duration of administration | ||
| Continued use of third generation aromatase inhibitors is recommended until disease progression or unacceptable toxicity | I | NBOCC3 * |
| Recommended doses and schedules for third generation aromatase inhibitors are: Anastrozole 1.0 mg/day Exemestane 25 mg/day Letrozole 2.5 mg/day |
I | NBOCC3 * |
| There are insufficient data to recommend one type of endocrine therapy over another for women who have progressed during or after treatment with adjuvant aromatase inhibitors | ||
* In February 2008, National Breast Cancer Centre (NBCC), incorporating the Ovarian Cancer Program, changed its name to National Breast and Ovarian Cancer Centre (NBOCC). In July 2011, NBOCC amalgamated with Cancer Australia to form a single national agency, Cancer Australia, to provide leadership in cancer control and improve outcomes for Australians affected by cancer.
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