This protocol applies to patients with solid papillary carcinoma of the breast with evidence of invasion who present with recurrent or metastatic disease.
At the time of first relapse, ER and HER2 receptor status should be confirmed — either from the original tumour specimen or from a biopsy of a recurrent or metastatic lesion — if not previously documented. Receptor status directly shapes systemic therapy selection.
Options include palliative cytotoxic chemotherapy delivered as either single-agent or combination regimens. For patients whose tumours are HER2 positive, targeted therapy may also be considered — alone or alongside chemotherapy. The full regimen selection, sequencing, and eligibility criteria are detailed in the complete protocol.
If not previously documented, ER and HER2 status should be determined at time of first relapse either from the original tumour specimen or biopsy from a recurrent or metastatic lesion.
Trastuzumab can be considered for HER2 positive patients and used as single agent or in combination with chemotherapy.
Lapatinib is not currently approved by NICE but may be considered with capecitabine in trastuzumab resistant patients.
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