Treatment of Solid Papillary Carcinoma of Breast with Evidence of Invasion in Recurrent or Metastatic Disease
Clinical Scenario
This protocol addresses solid papillary carcinoma of the breast with evidence of invasion presenting as recurrent or metastatic breast cancer. At first relapse, receptor status should be confirmed — if not previously documented, ER and HER2 status should be assessed from the original tumour specimen or from a biopsy of a recurrent or metastatic lesion, as this directly informs the treatment approach.
Treatment Approach (partial overview)
The primary treatment strategy in this setting is hormonal therapy, with the specific regimen determined by menopausal status and prior endocrine therapy exposure. Different options apply depending on whether the patient is pre- or post-menopausal and what systemic therapy has been received previously.
The full algorithm — including which agent to use, sequencing after prior therapy, and considerations for patients where surgery is not an option — is available in the complete structured protocol.
References
- If not previously documented, ER and HER 2 status should be determined at time of first relapse either from the original tumour specimen or biopsy from a recurrent or metastatic lesion.
- In pre-menopausal who have received prior treatment with tamoxifen, gosarelin 3.6 mg subcutaneously once monthly and / or an aromatase inhibitor should be considered.
- If ER positive and no prior endocrine therapy has been given patients should receive tamoxifen.
- In post-menopausal who have received prior treatment with tamoxifen, an aromatase inhibitor should be given.
- If they have had prior treatment with anastrozole or letrozole, they should be offered exemestane, or tamoxifen if not previously exposed.
- Fulvestrant should be considered for those patients who are intolerant of or are not able to comply with oral medication.
- For those patients who are primarily inoperable, or where operative intervention is declined, primary therapy with Letrozole 2.5 mg per day should be offered.
View source ↗