From the Guidelines
Breast cancer treatment should be individualized based on several prognostic and predictive factors, including tumor histology, clinical and pathologic characteristics, axillary lymph node status, tumor hormone receptor content, and HER2 status, as outlined in the NCCN clinical practice guidelines 1. The treatment approach for breast cancer typically involves a combination of local and systemic therapies, such as surgery, radiation therapy, chemotherapy, endocrine therapy, biologic therapy, or combinations of these.
- The need for and selection of various local or systemic therapies are based on several factors, including:
- Tumor histology
- Clinical and pathologic characteristics of the primary tumor
- Axillary lymph node (ALN) status
- Tumor hormone receptor (estrogen receptor [ER]/progesterone receptor [PR]) content
- Tumor HER2 status
- Multigene testing
- Presence or absence of detectable metastatic disease
- Patient comorbid conditions
- Patient age
- Menopausal status Breast cancer can be divided into several categories, including:
- Pure noninvasive carcinomas (stage 0)
- Operable, locoregional invasive carcinoma (clinical stage I, stage II, and some stage IIIA tumors)
- Inoperable locoregional invasive carcinoma (clinical stage IIIB, stage IIIC, and some stage IIIA tumors)
- Metastatic (stage IV) or recurrent carcinoma Patient preference plays a significant role in the decision-making process, especially when survival rates are equivalent among the available treatment options, as noted in the NCCN guidelines 1.
From the FDA Drug Label
1 INDICATIONS AND USAGE
1.1 Adjuvant Breast Cancer Ogivri is indicated in adults for adjuvant treatment of HER2 overexpressing node positive or node negative (ER/PR negative or with one high risk feature [see Clinical Studies (14. 1)]) breast cancer as part of a treatment regimen consisting of doxorubicin, cyclophosphamide, and either paclitaxel or docetaxel as part of a treatment regimen with docetaxel and carboplatin as a single agent following multi-modality anthracycline based therapy.
1.2 Metastatic Breast Cancer Ogivri is indicated in adults: In combination with paclitaxel for first-line treatment of HER2-overexpressing metastatic breast cancer As a single agent for treatment of HER2-overexpressing breast cancer in patients who have received one or more chemotherapy regimens for metastatic disease
The trastuzumab (IV) drug is indicated for the treatment of breast cancer, specifically:
- Adjuvant breast cancer: for adults with HER2 overexpressing node positive or node negative breast cancer
- Metastatic breast cancer: in combination with paclitaxel for first-line treatment, or as a single agent for treatment of HER2-overexpressing breast cancer in patients who have received one or more chemotherapy regimens for metastatic disease 2 2.
The paclitaxel (IV) drug is also used in the treatment of breast cancer, specifically:
- For the adjuvant treatment of node-positive breast cancer, the recommended regimen is paclitaxel, at a dose of 175 mg/m2 intravenously over 3 hours every 3 weeks for 4 courses administered sequentially to doxorubicin-containing combination chemotherapy 3.
- After failure of initial chemotherapy for metastatic disease or relapse within 6 months of adjuvant chemotherapy, paclitaxel at a dose of 175 mg/m2 administered intravenously over 3 hours every 3 weeks has been shown to be effective 3.
From the Research
Treatment Options for Breast Cancer
- Breast-conserving therapy (lumpectomy) followed by radiation therapy is a viable treatment option for early-stage breast cancer, with equivalent results to mastectomy at 10 years 4.
- The choice between breast-conserving surgery and mastectomy depends on various factors, including tumor size, location, and patient preference 5.
- For patients with stage I or II breast cancer, breast-conserving surgery followed by radiotherapy is generally recommended, unless there are special reasons to select mastectomy 5.
Stages of Breast Cancer
- Stage III breast cancer can be treated with a combined modality strategy, including primary chemotherapy, surgery, and radiation therapy, with a 5-year disease-free survival rate of 84% for patients with Stage IIIA disease and 33% for patients with Stage IIIB disease 6.
- For healthy women aged 70 years or older with hormone receptor-positive early-stage breast cancer, lumpectomy plus hormone or radiation therapy alone can produce equivalent survival outcomes 7.
Triple-Negative Breast Cancer
- Triple-negative breast cancer (TNBC) often requires a combination of surgery, radiation, and chemotherapy, with a focus on breast-conserving therapy and sufficient margins 8.
- Radiation therapy and chemotherapy are essential components of TNBC treatment, with neoadjuvant chemotherapy producing pathological complete response rates higher than 20% in patients with TNBC 8.