Breast cancer

Educational Objective: Identify appropriate adjuvant systemic treatment options for premenopausal patients with hormone receptor-positive (HR+) human epidermal growth factor receptor 2-negative (HER2-) early breast cancer (EBC).

Specialty: Medical oncology, Clinical oncology, Obstetrics & Gynaecology, (Surgical oncology), (Radiation oncology)

Target Audience: CME (basic, intermediate), Residents (senior)

Latest update: January 2024

Background:

In HR+ HER2- breast cancer, there is a high risk for distant recurrence in the long term, which is strongly correlated with the original tumour diameter and nodal status [1]. The treatment strategy for each patient should be based on an individual risk-benefit analysis considering the tumour burden (size and location of the primary tumour, number of lesions and extent of lymph node involvement) and biology (pathology, including biomarkers and gene expression), as well as age, menopausal status, general health status and patient preferences [2].

Tumours are grouped into surrogate intrinsic subtypes based on routine histology and immunohistochemistry data [2]. In this course, only premenopausal patients with luminal A and luminal B and HER2- disease are included.

ER: oestrogen receptor; PgR: progesterone receptor

Regulatory approval status of endocrine and targeted therapies for HR+ HER2- EBC (status 22 June 2023)

1. Pan H, Gray R, Braybrooke J, et al. N Engl J Med 2017;377:1836-46. PubMed
2. Loibl S, André F, Bachelot T, et al. Ann Oncol 2023;doi:10.1016/j.annonc.2023.11.016. PubMed