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Recommendations for use of Endocrine therapy

Clinical practice recommendations

Recommendations to individuals should be based on the risks, the absolute benefits and harms of treatment, and their personal preference. These factors should be discussed with the woman. Women receiving endocrine therapy should be reviewed regularly and monitored for adverse events by clinicians familiar with endocrine therapy.

RECOMMENDATIONS LEVEL OF EVIDENCE20 REFERENCE
In women with hormone receptor-positive advanced breast cancer:
Endocrine therapy is recommended in preference to chemotherapy except in the presence of rapidly progressive visceral disease I Cochrane 20034
Information about the treatment should be discussed with the patient. The patient should be adequately prepared for the treatment I NBCC* & NCCI22
In pre-menopausal women with hormone receptor-positive advanced breast cancer:
Tamoxifen combined with luteinising hormone-releasing hormone (LH-RH) agonist is recommended in favour of a LH-RH agonist alone I Klijn 20012
If commencing treatment with tamoxifen alone, consideration should be given to adding a LH-RH agonist, if response is not optimal III Klijn 20005
Optimal dose and schedule of administration
Recommended doses and schedule are:
Tamoxifen 20mg/day
Goserelin 3.6mg subcutaneously monthly
Therapeutic Goods Administration23
In post-menopausal women with hormone receptor-positive advanced breast cancer:
Aromatase inhibitors with trastuzumab are recommended for the treatment of women with HER2-positive hormone dependent advanced breast cancer in preference to aromatase inhibitors alone II NBCC21 *
First-line treatment
Third generation aromatase inhibitors are recommended in preference to tamoxifen I NBOCC3 *
Second-line treatment
(following progression on tamoxifen)
Third generation aromatase inhibitors are recommended in preference to progestins I NBOCC3 *
Optimal dose, schedule and duration of administration
Continued use of third generation aromatase inhibitors is recommended until disease progression or unacceptable toxicity I NBOCC3 *
Recommended doses and schedules for third generation aromatase inhibitors are:
Anastrozole 1.0 mg/day
Exemestane 25 mg/day
Letrozole 2.5 mg/day
I NBOCC3 *
There are insufficient data to recommend one type of endocrine therapy over another for women who have progressed during or after treatment with adjuvant aromatase inhibitors

* In February 2008, National Breast Cancer Centre (NBCC), incorporating the Ovarian Cancer Program, changed its name to National Breast and Ovarian Cancer Centre (NBOCC). In July 2011, NBOCC amalgamated with Cancer Australia to form a single national agency, Cancer Australia, to provide leadership in cancer control and improve outcomes for Australians affected by cancer.

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