Current treatment paradigm* following progression
after endocrine treatment for HR+ ABC
Progression on
endocrine therapy
in adjuvant/
advanced setting
Alternate endocrine options
•
Exemestane
•
Fulvestrant
Chemotherapy
•
Taxanes
•
Anthracyclines
•
Other
Resistance to ER-
directed therapy
Should be restricted to
patients in need of rapid
symptom control
NCCN
ABC3
Recommend 3 consecutive
endocrine therapy regimens
before switching to chemotherapy
No consensus following initial AI
therapy; options include
•
Tamoxifen
•
Another AI
•
Fulvestrant
•
Megestrol acetate
AIs, aromatase inhibitors; ER, estrogen receptor; HR, hormone receptor; NCCN, National Comprehensive Cancer Center.
*Guidelines refer to postmenopausal HR+ advanced breast cancer, and recommend endocrine therapy for patients who are not in visceral crisis.
