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Oncologic Treatment of Breast Cancer

Adjuvant therapy

Authors: Sarah Gierahn Nielsen, med. student & Hanne Melgaard Nielsen, MD

Types of adjuvant therapy

  • Chemotherapy
    • Epirubicin concomitant with cyclophosphamide followed by
    • Docetaxel or Paclitaxel
  • Endocrine therapy (adjuvant hormone therapy)
    • Tamoxifen
    • Aromatase inhibitors
  • Targeted therapy
    • Trastuzumab (Herceptin)
  • Radiotherapy

Adjuvant therapy for breast cancer is designed to treat micrometastatic disease, or breast cancer cells that have escaped the breast and regional lymph nodes, but have not yet established an identifiable metastasis. It lowers the risk that the cancer will come back (recurrent cancer). Adjuvant therapy consist of the following possibilities: chemotherapy, endocrine therapy, anti-HER 2 therapy and bisphosphonates. There are several individual treatment options depending on type of surgery, radicality of the surgery, tumor characteristics and the patients’ age. That emphasizes the need for a specific individual treatment plan for each patient. For more detailed treatment plans, please visit the chapters above.

Adjuvant chemotherapy should be considered when:

  • Tumor size is >2 cm (prognostic factor)
  • Axillary lymph node involvement
  • Pathological verified high-grade cancer cells
  • Estrogen receptor negative tumor (ER-)
  • Human Epidermal Growth factor receptor-2 positive tumor (HER2+)
  • Young age

Endocrine treatment should be considered when:

  • Estrogen receptor positive tumor (ER +)
  • Except lowrisk patients (see below)

Anti-HER-2 should be considered when:

  • Human Epidermal Growth factor receptor-2 positive tumor (HER2+)

Adjuvant Bisphosphonates should be considered when:

  • The patient is postmenopausal and NOT low risk
  • Patient with age-related mortality
  • Patients aged 60 years or older:
    • without metastatic lymph nodes
    • tumor size <= 10 mm if the tumor is
      • Grade 1 ductal carcinoma
      • Grade 1 or 2 lobular carcinoma
      • Estrogen receptor positive (ER+)
      • HER2+ negative
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