Endocrine Therapy for Systemic (Metastatic) Disease

This information is taken from the NCCN Practice Guidelines in Oncology (v.1.2012) *registration required*

 Subsequent Endocrine Therapy for Systemic Disease (page BINV-L)

  • “The NCCN Clinical Practice Guidelines in Oncology™ – the recognized standard of care in oncology – are the most comprehensive and most frequently updated clinical practice guidelines available in any area of Medicine. Covering 97 percent of all patients with cancer and updated on a continual basis, the NCCN Guidelines are developed through an explicit review of the evidence integrated with expert medical judgment by multidisciplinary panels from NCCN Member Institutions.” 
  • NCCN uses different levels of evidence in its practice guidelines, and indicates that all of these recommendations are considered Category  2A unless otherwise noted.  Category 2A means complete consensus among the NCCN breast cancer panel members, based on lower level evidence (than Category 1), including clinical experience, that the recommendation is appropriate.    
  • Premenopausal patients with ER-positive disease should have ovarian ablation/suppression and follow postmenopausal guidelines.

Note: In premenopausal women, the ovaries are the primary source of estrogen.  Ovarian ablation can be accomplished through monthly injections with an LHRH agonist like Zoladex (goserelin) or Lupron (leuprolide) which stop ovarian function, or less commonly through surgical removal of the ovaries (oophorectomy).

  • Endocrine therapy for postmenopausal patients:
    • Non-steroidal aromatase inhibitor:  Arimidex (anastrozole), Femara (letrozole)
    • Steroidal aromatase inactivato: Aromasin (exemestane)
    • Faslodex (fulvestrant)
    • Tamoxifen or Fareston (toremifene)
    • Megace (megestrol acetate)
    • Halotestin (fluoxymestrone) 
    • Estrogen (ethinyl estradiol)