Metastatic Breast Cancer: RAOM Clinical Practice Guidelines
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1 Russian Association of Oncological Mammology / Clinical recommendations of the Russian Brest Cancer Society for neoadjuvant and adjuvant therapy of breast cancer (electronic version). Clinical recommendations of the Russian Brest Cancer Society for the of metastatic breast cancer (electronic version). Metastatic Breast Cancer: RAOM Clinical Practice Guidelines Authors: Prof. V.F. Semiglazov, R.M. Paltuev, A.G. Manikhas, Prof. R.V. Orlova, Expert Panel
2 Russian public organization Russian society of the Mammary Gland Cancer Specialists All rights reserved. No part of this book may not be reproduced in whatever form and, by whatever means without the written permission of the copyright holder.
3 Author team Vladimir Semiglazov President of the Russian Brest Cancer Society Dr., prof., academician of the Russian Academy of Natural Sciences, correspondent member of the Russian Academy of Medical Sciences, from 1989 to the present time heads surgical Department of the Oncology Research Institute named after Petrov of the Russian Ministry of Health Ruslan Paltuev Executive director of the Russian Brest Cancer Society Dr., deputy chief physician of the Specialized Medical Help of the Road Hospital of the Russian Railways Company RZD Aleksey Manikhas Dr., the doctor of the first category, surgeon, oncologist, head of the Surgical Oncology (Mammary Gland Cancer) Department of the St. Petersburg Clinical Hospital City Clinical Cancer Dispensary Rashida Orlova Dr., prof., scientific consultant of anticancer drug therapy of the S-Petersburg City Clinical Cancer Dispensary 1 All rights reserved. No part of this book may be reproduced in any form and, by any means without the written permission of the copyright holder.
4 Expert Panel Vladimir Semiglazov President of the Russian Brest Cancer Society Dr., prof., academician of the Russian Academy of Natural Sciences, correspondent member of the Russian Academy of Medical Sciences, head of Department of the Tumors of Reproductive System of the Oncology Research Institute of the Russian Ministry of Health Georgiy Manikhas Vice-President of the Russian Brest Cancer Society Dr., correspondent member of the Russian Academy of Natural Sciences, honored doctor of the Russian Federation, chief doctor of the St. Petersburg City Clinical Oncological Dispensary, head of the Oncology Department of the Faculty of Postgraduate Education of the First St. Petersburg State Medical University named Pavlov Elena Artamonova Dr., leading researcher of the New Anticancer Drugs Research Department of the Russian Oncological Scientific Center Natalia Besova Dr., senior researcher of the Department of the Russian Oncological Scientific Center named after Blokhin Alla Bozhok Dr., leading researcher of the Breast Gland Tumors Department of the Federal State Organization Oncology Research Institute Vladimir Vladimirov Dr., deputy chief doctor for tech support Eduard Vozny Dr., prof., head of the Department of the Moscow State Clinical Hospital 57 Vera Gorbunova Dr., prof., head of the Department of the Russian Oncological Scientific Center named after Blokhin 2 All rights reserved. No part of this book may be reproduced in any form and, by any means without the written permission of the copyright holder.
5 Garik Dashian Dr., senior researcher of the Breast Gland Tumors Department of the Federal State Organization Oncology Research Institute named after Petrov Sergey Demidov Dr., prof., head of the Oncology and Medical Radiology Department of the Ural Medical University, head of the Breast Cancer Department of the Yekaterinburg State Clinical Hospital 40 Natalia Zakharova Dr., associate Professor of the Department of Oncology and Surgery, Radiodiagnosis and Radiation Therapy of the Khanty- Mansiysk State Medical Academy Aziz Zakiriakhodjaev Dr., acting head of the Oncology and Reconstructive Plastic Surgery, Breast and Skin Department of the Moscow Cancer Research Institute named after Gertsen Artur Ismagilov Dr., prof., leading reconstructive surgeon of the Volga Branch of the Russian Oncological Scientific Center named after Blokhin, oncologist mammologist of the Mammology Department of the Republican Cancer Dispensary, President of the International Association of Plastic Surgeons and Oncologists Maria Konstantinova Dr., prof., Deputy Director on medical work, chief doctor of the Vishnevsky Institute of Surgery Luiza Korytova Dr., prof., Honored worker of science, head of the Department of Quality Assurance of Radiation Therapy of the Russian Scientific Centre for Radiology and Surgical Technologies Aleksandr Lazarev Dr., prof., director of the Altai Branch of the Russian Oncological Scientific Center named after Blokhin, chief doctor of the Regional State Clinical Hospital Altai Regional Oncology Dispensary 3 All rights reserved. No part of this book may be reproduced in any form and, by any means without the written permission of the copyright holder.
6 Aleksey Manikhas Dr., the doctor of the first category, surgeon, oncologist, head of the Surgical Oncology (mammary gland cancer) Department of the St. Petersburg Clinical Hospital City Clinical Cancer Dispensary Liudmila Manziuk Dr., prof., doctor of higher category, head of the New Anticancer Drugs Research Department of the Russian Oncological Scientific Center named after Blokhin Rashida Orlova Dr., prof., scientific consultant of anticancer drug therapy of the S-Petersburg City Clinical Cancer Dispensary Ruslan Paltuev Executive Director of the Russian Brest Cancer Society Dr., deputy chief physician of the Specialized Medical Help of the Road Hospital of the Russian Railways Company RZD Natalia Perevodchikova Dr., prof., leading research worker of the Department of the Russian Oncological Scientific Center named after Blokhin Kazimir Pozharisskiy Dr., prof., head of the laboratory, academician of the Russian Academy of Natural Sciences, member of the International Academy of Pathology, laureate of the prize of the Government of the Russian Federation in science and technology, doctor-pathologist of the highest qualification category Sergey Portnoy Dr., prof., leading researcher of the Surgical Department of of the Russian Oncological Scientific Center named after Blokhin Vladislav Semiglazov Dr., prof., head of the Oncology Department of the St. Petersburg State Medical University named after Pavlov 4 All rights reserved. No part of this book may be reproduced in any form and, by any means without the written permission of the copyright holder.
7 Tatiana Semiglazova Senior researcher of the Therapeutic Oncology Department, associate Professor of Department of the Northwestern State Medical University named after Mechnikov Elena Solonimskaya Dr., prof., head of the General Oncology Department of the Oncology Research Institute of the Siberian Branch of the Russian Academy of Medical Sciences, Tomsk Daniel Stroyakovsky КDr., head of the Department of the Moscow State Oncology Hospital 62 Eldar Topuzov Dr., prof., head of the Oncology Department of the Clinic of the St. Petersburg State Medical Academy Victor Khaylenko Dr., prof., academician of the Russian Academy of Natural Sciences, head of the Oncology Department of the Faculty of Doctors Improvement of the Russian National Research Medical University named after Pirogov, leading researcher of the Surgical Department 2 of the Clinical Oncology Research Institute of the Russian Oncological Scientific Center Oleg Chagunava Dr., chief doctor of the St.Petersburg Clinical Hospital of the Russian Academy of Sciences Sergey Shinkarev Dr., chief doctor of the Lipetsk Regional Oncology Dispensary 5 All rights reserved. No part of this book may be reproduced in any form and, by any means without the written permission of the copyright holder.
8 6 Systemic treament of metastatic breast cancer (ER/PgR positive HER2 negative) (Tab.1) Premenopausal Prof.V.F.Semiglazov, R.M.Paltuev., A.G.Manichas 2013 time over 5 years. B. No visceral C. No clinical manifestations Previous Hormonal Preferable standart (A) standart (B) Hormonal «А» «B» Antracycline chemotherapy Tamoxifen Taxane chemotherapy Taxane chemotherapy docetaxel Tamoxifen Antracycline chemotherapy Antracycline chemotherapy Paclitaxel Tamoxifen Antracycline chemotherapy Antracycline chemotherapy Docetaxel + Tamoxifen 1 patient should Capecitabine, Tegafur antracycline recieve minimum 2 chemotherapy regimens previously. ± ovarian supression ± ovarian supression ± ovarian supression ± ovarian supression
9 Systemic treament of metastatic breast cancer (ER/PgR positive HER2 negative) (Tab.1) Premenopausal (continue) Prof.V.F.Semiglazov, R.M.Paltuev., A.G.Manichas 2013 time over 5 years. B. No visceral C. No clinical manifestations Previous Hormonal Preferable standart (A) standart (B) Hormonal «А» «B» Paclitaxel + antracycline tegafur capecitabine capecitabine +drugs from «A» and «B» columns Tamoxifen 1 patient should recieve minimum 2 chemotherapy regimens previously. Tamoxifen Tamoxifen Tamoxifen If not used in privious regimens: Capecitabine, Tegafur Capecitabine, Platinum agents Vinorelbine If not used in privious regimens Vinorelbine or Change Taxane regimen ± ovarian supression ± ovarian supression ± ovarian supression ± ovarian supression 7
10 8 Systemic treament of metastatic breast cancer (ER/PgR positive HER2 negative) (Tab.2) Premenopausal Prof.V.F.Semiglazov, R.M.Paltuev., A.G.Manichas 2013 time less then 5 years. B. Visceral C. Clinical manifestations Previous Hormonal Preferable standart (A) standart (B) Hormonal «А» «B» Antracycline chemotherapy Tamoxifen Taxane chemotherapy Taxane chemotherapy docetaxel Tamoxifen Antracycline chemotherapy Antracycline chemotherapy Paclitaxel Tamoxifen Antracycline chemotherapy Antracycline chemotherapy Docetaxel + Tamoxifen 1 patient should Capecitabine, Tegafur antracycline recieve minimum 2 chemotherapy regimens previously. ± ovarian supression ± ovarian supression ± ovarian supression ± ovarian supression
11 Systemic treament of metastatic breast cancer (ER/PgR positive HER2 negative) (Tab.2) Premenopausal (continue) Prof.V.F.Semiglazov, R.M.Paltuev., A.G.Manichas 2013 time less then 5 years. B. Visceral C. Clinical manifestations Paclitaxel + antracycline tegafur capecitabine capecitabine +drugs from «A» and «B» columns Previous Hormonal Preferable standart (A) Tamoxifen 1 patient should recieve minimum 2 chemotherapy regimens previously. Tamoxifen Tamoxifen Tamoxifen If not used in privious regimens: standart (B) Capecitabine, Tegafur Capecitabine, Platinum agents Vinorelbine If not used in privious regimens Vinorelbine or Change Taxane regimen «А» «B» ± ovarian supression ± ovarian supression ± ovarian supression ± ovarian supression 9
12 10 Systemic treament of metastatic breast cancer (ER/PgR negative HER2 negative) (Tab.3) Premenopausal Prof.V.F.Semiglazov, R.M.Paltuev., A.G.Manichas 2013 time over 5 years. B. No visceral C. No clinical manifestations Previous Preferable standart (A) standart (B) Antracycline chemotherapy Taxane chemotherapy Taxane chemotherapy docetaxel Antracycline chemotherapy Antracycline chemotherapy Paclitaxel Antracycline chemotherapy Antracycline chemotherapy Docetaxel + antracycline Ixabepilone+capecitabine 1 patient should recieve minimum 2 chemotherapy regimens previously. Capecitabine, Tegafur Paclitaxel + antracycline Ixabepilone+capecitabine Capecitabine, Tegafur
13 Systemic treament of metastatic breast cancer (ER/PgR negative HER2 negative) (Tab.3) Premenopausal (continue) Prof.V.F.Semiglazov, R.M.Paltuev., A.G.Manichas 2013 time over 5 years. B. No visceral C. No clinical manifestations Previous Preferable standart (A) standart (B) tegafur capecitabine capecitabine +drugs from «A» and «B» columns If not used in privious regimens: Capecitabine, Platinum agents Vinorelbine If not used in privious regimens Vinorelbine or Change Taxane regimen 11
14 12 Systemic treament of metastatic breast cancer (ER/PgR negative HER2 negative) (Tab.4) Premenopausal Prof.V.F.Semiglazov, R.M.Paltuev., A.G.Manichas 2013 time less then 5 years. B. Visceral C. Clinical manifestations Previous Preferable standart (A) standart (B) Antracycline chemotherapy Taxane chemotherapy Taxane chemotherapy docetaxel Antracycline chemotherapy Antracycline chemotherapy Paclitaxel Antracycline chemotherapy Antracycline chemotherapy Docetaxel + antracycline Ixabepilone+capecitabine 1 patient should recieve minimum 2 chemotherapy regimens previously. Capecitabine, Tegafur Paclitaxel + antracycline Ixabepilone+capecitabine Capecitabine, Tegafur
15 Systemic treament of metastatic breast cancer (ER/PgR negative HER2 negative) (Tab.4) Premenopausal (continue) Prof.V.F.Semiglazov, R.M.Paltuev., A.G.Manichas 2013 time less then 5 years. B. Visceral C. Clinical manifestations Previous Preferable standart (A) standart (B) tegafur capecitabine capecitabine +drugs from «A» and «B» columns If not used in privious regimens: Capecitabine, Platinum agents Vinorelbine If not used in privious regimens Vinorelbine or Change Taxane regimen 13
16 14 Systemic treament of metastatic breast cancer (ER/PgR positive HER2 positive) Premenopausal (Tab.5) Prof.V.F.Semiglazov, R.M.Paltuev., A.G.Manichas, R.V.Orlova 2013 time over 5 years. B. No visceral C. No clinical manifestations Taxane Taxane ± ovarian supression + Taxane Taxane ± ovarian supression Antracycline Previous Hormonal Tamoxifen Tamoxifen Target Antracycline Without docetaxel Tamoxifen docetaxel Tamoxifen Without Paclitaxel Tamoxifen Paclitaxel Tamoxifen Without Hormonal Target Preferable standart (A) standart (B) «А» «B» «А» «B» Paclitaxel Paclitaxel ± ovarian supression + Paclitaxel Paclitaxel ± ovarian supression docetaxel docetaxel ± ovarian supression + docetaxel docetaxel ± ovarian supression
17 Systemic treament of metastatic breast cancer (ER/PgR positive HER2 positive) Premenopausal (Tab.5) continue Prof.V.F.Semiglazov, R.M.Paltuev., A.G.Manichas, R.V.Orlova time over 5 years. B. No visceral C. No clinical manifestations tegafur Previous Hormonal Tamoxifen Tamoxifen Docetaxel + antracycline Docetaxel + antracycline Paclitaxel + antracycline Paclitaxel + antracycline tegafur Tamoxifen Tamoxifen Tamoxifen Target Without Hormonal Target Preferable standart (A) Ixabepilon 2 Ixabepilon 2 standart (B) Tamoxifen Capecitabine Without Capecitabine Capecitabine Without Capecitabine Capecitabine, Platinum agents Capecitabine, Platinum agents «А» «B» «А» «B» ± ovarian supression + ± ovarian supression ± ovarian supression + ± ovarian supression ± ovarian supression + ± ovarian supression
18 16 Systemic treament of metastatic breast cancer (ER/PgR positive HER2 positive) Premenopausal (Tab.5) continue Prof.V.F.Semiglazov, R.M.Paltuev., A.G.Manichas, R.V.Orlova 2013 time over 5 years. B. No visceral C. No clinical manifestations tegafur capecitabine capecitabine +drugs from «A» and «B» columns Previous Hormonal Target Hormonal Target Preferable standart (A) Tamoxifen Tamoxifen Without Tamoxifen If not used in privious regimens: standart (B) Platinum agents, Vinorelbine Platinum agents, Vinorelbine If not used in privious regimens Platinum agents, Vinorelbine or Change Taxane regimen «А» «B» «А» «B» ± ovarian supression + ± ovarian supression + ± ovarian supression
19 Systemic treament of metastatic breast cancer (ER/PgR positive HER2 positive) Premenopausal (Tab.6) Prof.V.F.Semiglazov, R.M.Paltuev., A.G.Manichas, R.V.Orlova 2013 Antracycline Taxane Taxane ± ovarian supression + Taxane Taxane ± ovarian supression Antracycline docetaxel Previous Hormonal Target Tamoxifen Tamoxifen Without Tamoxifen docetaxel Tamoxifen Without Paclitaxel Tamoxifen Paclitaxel Tamoxifen Without Hormonal Target time less then 5 years. B. Visceral C. Clinical manifestations Preferable standart (A) standart (B) «А» «B» «А» «B» Paclitaxel Paclitaxel ± ovarian supression + Paclitaxel Paclitaxel ± ovarian supression docetaxel docetaxel ± ovarian supression + docetaxel docetaxel ± ovarian supression 17
20 18 Systemic treament of metastatic breast cancer (ER/PgR positive HER2 positive) Premenopausal (Tab.6) continue Prof.V.F.Semiglazov, R.M.Paltuev., A.G.Manichas, R.V.Orlova 2013 time less then 5 years. B. Visceral C. Clinical manifestations of distant Docetaxel + antracycline Docetaxel + antracycline Paclitaxel + antracycline Paclitaxel + antracycline tegafur tegafur Previous Hormonal Tamoxifen Tamoxifen Tamoxifen Tamoxifen Tamoxifen Tamoxifen Target Without Hormonal Target Preferable standart (A) standart (B) Capecitabine Without Capecitabine Capecitabine Without Capecitabine Capecitabine, Platinum agents Capecitabine, Platinum agents «А» «B» «А» «B» ± ovarian supression + ± ovarian supression ± ovarian supression + ± ovarian supression ± ovarian supression + ± ovarian supression
21 Systemic treament of metastatic breast cancer (ER/PgR positive HER2 positive) Premenopausal (Tab.6) continue Prof.V.F.Semiglazov, R.M.Paltuev., A.G.Manichas, R.V.Orlova 2013 time less then 5 years. B. Visceral C. Clinical manifestations of distant tegafur capecitabine capecitabine +drugs from «A» and «B» columns Previous Hormonal Tamoxifen Tamoxifen Tamoxifen Target Without Hormonal Target Preferable standart (A) If not used in privious regimens: standart (B) Platinum agents, Vinorelbine Platinum agents, Vinorelbine If not used in privious regimens Platinum agents, Vinorelbine or Change Taxane regimen «А» «B» «А» «B» ± ovarian supression + ± ovarian supression + ± ovarian supression 19
22 20 Systemic treament of metastatic breast cancer (ER/PgR negative HER2 positive) Premenopausal (Tab.7) Prof.V.F.Semiglazov, R.M.Paltuev., A.G.Manichas, R.V.Orlova 2013 time over 5 years. B. No visceral C. No clinical manifestations Previous Target Preferable standart (A) standart (B) «А» Target Antracycline Taxane Taxane + Antracycline Without Taxane Taxane docetaxel Paclitaxel Paclitaxel + docetaxel Without Paclitaxel Paclitaxel Paclitaxel docetaxel docetaxel + Paclitaxel Without docetaxel docetaxel «B»
23 Systemic treament of metastatic breast cancer (ER/PgR negative HER2 positive) Premenopausal (Tab.7) continue Prof.V.F.Semiglazov, R.M.Paltuev., A.G.Manichas, R.V.Orlova 2013 time over 5 years. B. No visceral C. No clinical manifestations Previous Docetaxel + antracycline Docetaxel + antracycline Paclitaxel + antracycline Paclitaxel + antracycline tegafur tegafur Target Preferable standart (A) standart (B) «А» Target Capecitabine + Without Capecitabine Capecitabine + Without Without «B» Capecitabine Capecitabine, Platinum agents Capecitabine, Platinum agents + 21
24 22 Systemic treament of metastatic breast cancer (ER/PgR negative HER2 positive) Premenopausal (Tab.7) continue Prof.V.F.Semiglazov, R.M.Paltuev., A.G.Manichas, R.V.Orlova 2013 time over 5 years. B. No visceral C. No clinical manifestations Previous capecitabine capecitabine capecitabine +drugs from «A» and «B» columns Target Preferable standart (A) Without If not used in privious regimens: standart (B) Vinorelbine Vinorelbine If not used in privious regimens Vinorelbine or Change Taxane regimen «А» + + Target «B»
25 Systemic treament of metastatic breast cancer (ER/PgR negative HER2 positive) Premenopausal (Tab.8) Prof.V.F.Semiglazov, R.M.Paltuev., A.G.Manichas, R.V.Orlova 2013 time less then 5 years. B. Visceral C. Clinical manifestations of distant Previous Target Preferable standart (A) standart (B) «А» Target Antracycline Taxane Taxane + Antracycline Without Taxane Taxane docetaxel Paclitaxel Paclitaxel + docetaxel Without Paclitaxel Paclitaxel Paclitaxel docetaxel docetaxel + Paclitaxel Without docetaxel docetaxel «B» 23
26 24 Systemic treament of metastatic breast cancer (ER/PgR negative HER2 positive) Premenopausal (Tab.8) continue Prof.V.F.Semiglazov, R.M.Paltuev., A.G.Manichas, R.V.Orlova 2013 time less then 5 years. B. Visceral C. Clinical manifestations of distant Previous Docetaxel + antracycline Docetaxel + antracycline Paclitaxel + antracycline Paclitaxel + antracycline tegafur tegafur Target Preferable standart (A) standart (B) «А» Target Capecitabine + Without Capecitabine Capecitabine + Without Without Eribulin1 Ixabepilon2 Eribulin1 Ixabepilon2 «B» Capecitabine Capecitabine, Platinum agents Capecitabine, Platinum agents +
27 Systemic treament of metastatic breast cancer (ER/PgR negative HER2 positive) Premenopausal (Tab.8) continue Prof.V.F.Semiglazov, R.M.Paltuev., A.G.Manichas, R.V.Orlova 2013 time less then 5 years. B. Visceral C. Clinical manifestations of distant Previous capecitabine capecitabine capecitabine +drugs from «A» and «B» columns Target Without Preferable standart (A) Eribulin1 Ixabepilon2 Eribulin1 Ixabepilon2 If not used in privious regimens: Eribulin1 Ixabepilon2 standart (B) Vinorelbine Vinorelbine If not used in privious regimens Vinorelbine or Change Taxane regimen «А» + + Target «B» 25
28 26 Systemic treament of metastatic breast cancer (ER/PgR positive HER2 negative) (Tab.9) Postmenopause Prof.V.F.Semiglazov, R.M.Paltuev., A.G.Manichas 2013 time over 5 years. B. No visceral C. No clinical manifestations Previous Hormonal Preferable standart (A) standart (B) Hormonal «А» «B» Antracycline Antracycline tamoxifen «-» «-» If tamoxifen used in first line therapy allowed therapy with Fulvestrant «-» «-» Fulvestrant 5 If non-steroid used in first line therapy allowed therapy with Everolimus 6 + Steroid Steroid
29 Systemic treament of metastatic breast cancer (ER/PgR positive HER2 negative) (Tab.9) Postmenopause (continue) Prof.V.F.Semiglazov, R.M.Paltuev., A.G.Manichas 2013 time over 5 years. B. No visceral C. No clinical manifestations of distant Previous Hormonal Preferable standart (A) standart (B) Hormonal «А» «B» Antracycline Antracycline Steroid Tamoxifen + (steroid and non-steroid) «-» «-» Everolimus 6 +, Fulvestrant 5 Everolimus 6 + inhibitor change, Fulvestrant 5 Megestrol 27
30 28 Systemic treament of metastatic breast cancer (ER/PgR positive HER2 negative) (Tab.10) Postmenopause Prof.V.F.Semiglazov, R.M.Paltuev., A.G.Manichas 2013 time less then 5 years. B. Visceral C. Clinical manifestations Previous Hormonal tamoxifen Preferable standart (A) standart (B) Hormonal «А» If tamoxifen used in first line therapy allowed therapy with Fulvestrant Fulvestrant 5 If non-steroid used in first line therapy allowed therapy with Everolimus 6 + Steroid «B» Steroid
31 Systemic treament of metastatic breast cancer (ER/PgR positive HER2 negative) (Tab.10) Postmenopause continue Prof.V.F.Semiglazov, R.M.Paltuev., A.G.Manichas 2013 time less then 5 years. B. Visceral C. Clinical manifestations Previous Hormonal Preferable standart (A) standart (B) Hormonal «А» «B» Steroid Tamoxifen + (steroid and non-steroid) Everolimus 6 +, Fulvestrant 5 Everolimus 6 + inhibitor change, Fulvestrant 5 Megestrol 29
32 30 Systemic treament of metastatic breast cancer (ER/PgR negative HER2 negative) (Tab.11) Postmenopause Prof.V.F.Semiglazov, R.M.Paltuev., A.G.Manichas 2013 time over 5 years. B. No visceral C. No clinical manifestations Previous Preferable standart (A) standart (B) Antracycline chemotherapy Taxane chemotherapy Taxane chemotherapy docetaxel Antracycline chemotherapy Antracycline chemotherapy Paclitaxel Antracycline chemotherapy Antracycline chemotherapy Docetaxel + antracycline Ixabepilone+capecitabine 1 patient should recieve minimum 2 chemotherapy regimens previously. Capecitabine, Tegafur Paclitaxel + antracycline Ixabepilone+capecitabine Capecitabine, Tegafur
33 Systemic treament of metastatic breast cancer (ER/PgR negative HER2 negative) (Tab.11) Postmenopause continue Prof.V.F.Semiglazov, R.M.Paltuev., A.G.Manichas 2013 time over 5 years. B. No visceral C. No clinical manifestations Previous Preferable standart (A) standart (B) tegafur capecitabine capecitabine +drugs from «A» and «B» columns Ixabepilone+capecitabine 3 Ixabepilone 2, If not used in privious regimens: Capecitabine, Platinum agents Vinorelbine If not used in privious regimens Vinorelbine or Change Taxane regimen 31
34 32 Systemic treament of metastatic breast cancer (ER/PgR negative HER2 negative) (Tab.12) Postmenopause Prof.V.F.Semiglazov, R.M.Paltuev., A.G.Manichas 2013 time less then 5 years. B. Visceral C. Clinical manifestations of distant Previous treatmen Preferable standart (A) standart (B) Antracycline chemotherapy Taxane chemotherapy Taxane chemotherapy docetaxel Antracycline chemotherapy Antracycline chemotherapy Paclitaxel Antracycline chemotherapy Antracycline chemotherapy Docetaxel + antracycline Ixabepilone+capecitabine 3 Capecitabine, Tegafur Paclitaxel + antracycline Ixabepilone+capecitabine 3 Capecitabine, Tegafur
35 Systemic treament of metastatic breast cancer (ER/PgR negative HER2 negative) (Tab.12) Postmenopause continue Prof.V.F.Semiglazov, R.M.Paltuev., A.G.Manichas 2013 time less then 5 years. B. Visceral C. Clinical manifestations of distant Previous Preferable standart (A) standart (B) tegafur capecitabine capecitabine +drugs from «A» and «B» columns Ixabepilone+capecitabine 3 Ixabepilone 2, Eribulin1 If not used in privious regimens: Capecitabine, Platinum agents Vinorelbine If not used in privious regimens Vinorelbine or Change Taxane regimen 33
36 34 Systemic treament of metastatic breast cancer (ER/PgR positive HER2 positive) (Tab.13) Postmenopause Prof.V.F.Semiglazov, R.M.Paltuev., A.G.Manichas 2013 А. reccurencefree time over 5 years. B. No visceral C. No clinical manifestations Previous Hormonal Target Hormonal Target Preferable standart (A) standart (B) «А» «B» «А» «B» + + tamoxifen tamoxifen Without Without Steroid Steroid Steroid Steroid
37 Systemic treament of metastatic breast cancer (ER/PgR positive HER2 positive) (Tab.13) Postmenopause continue Prof.V.F.Semiglazov, R.M.Paltuev., A.G.Manichas 2013 Previous Hormonal Target Hormonal Target Preferable standart (A) time over 5 years. B. No visceral C. No clinical manifestations standart (B) «А» «B» «А» «B» + Steroid Steroid Without 35
38 36 Systemic treament of metastatic breast cancer (ER/PgR positive HER2 positive) (Tab.14) Postmenopause Prof.V.F.Semiglazov, R.M.Paltuev., A.G.Manichas 2013 Previous Hormonal Target Hormonal Target Preferable standart (A) time less then 5 years. B. Visceral C. Clinical manifestations of distant standart (B) «А» «B» «А» «B» + + tamoxifen tamoxifen Without Without Steroid Steroid Steroid Steroid
39 Systemic treament of metastatic breast cancer (ER/PgR positive HER2 positive) (Tab.14) Postmenopause continue Prof.V.F.Semiglazov, R.M.Paltuev., A.G.Manichas Previous Hormonal Steroid Steroid Target Hormonal Target Preferable standart (A) Without time less then 5 years. B. Visceral C. Clinical manifestations of distant standart (B) «А» «B» «А» «B» 37
40 38 Systemic treament of metastatic breast cancer (ER/PgR negative HER2 positive) (Tab.15) Postmenopause Prof.V.F.Semiglazov, R.M.Paltuev., A.G.Manichas, Prof. R.V.Orlova 2013 time over 5 years. B. No visceral C. No clinical manifestations Previous Target Preferable standart (A) standart (B) «А» Target «B» Antracycline Taxane Taxane + Antracycline Without Taxane Taxane docetaxel Paclitaxel Paclitaxel + docetaxel Without Paclitaxel Paclitaxel Paclitaxel docetaxel docetaxel + Paclitaxel Without docetaxel docetaxel
41 Systemic treament of metastatic breast cancer (ER/PgR negative HER2 positive) (Tab.15) Postmenopause continue Prof.V.F.Semiglazov, R.M.Paltuev., A.G.Manichas, Prof. R.V.Orlova 2013 time over 5 years. B. No visceral C. No clinical manifestations Previous Target Preferable standart (A) standart (B) «А» Target «B» Docetaxel + antracycline Docetaxel + antracycline Paclitaxel + antracycline Paclitaxel + antracycline tegafur tegafur Capecitabine + Without Capecitabine Capecitabine + Without Without Capecitabine Capecitabine, Platinum agents Capecitabine, Platinum agents + 39
42 40 Systemic treament of metastatic breast cancer (ER/PgR negative HER2 positive) (Tab.15) Postmenopause continue Prof.V.F.Semiglazov, R.M.Paltuev., A.G.Manichas, Prof. R.V.Orlova 2013 time over 5 years. B. No visceral C. No clinical manifestations Previous Target Preferable standart (A) standart (B) «А» Target «B» capecitabine capecitabine capecitabine +drugs from «A» and «B» columns Without If not used in privious regimens: Vinorelbine Vinorelbine If not used in privious regimens Vinorelbine or Change Taxane regimen + +
43 Systemic treament of metastatic breast cancer (ER/PgR negative HER2 positive) (Tab.16) Postmenopause Prof.V.F.Semiglazov, R.M.Paltuev., A.G.Manichas, Prof. R.V.Orlova 2013 time less then 5 years. B. Visceral C. Clinical manifestations Previous Target Preferable standart (A) standart (B) «А» Target Antracycline Taxane Taxane + Antracycline Without Taxane Taxane docetaxel Paclitaxel Paclitaxel + docetaxel Without Paclitaxel Paclitaxel Paclitaxel docetaxel docetaxel + Paclitaxel Without docetaxel docetaxel «B» 41
44 42 Systemic treament of metastatic breast cancer (ER/PgR negative HER2 positive) (Tab.16) Postmenopause continue Prof.V.F.Semiglazov, R.M.Paltuev., A.G.Manichas, Prof. R.V.Orlova 2013 time less then 5 years. B. Visceral C. Clinical manifestations Previous Docetaxel + antracycline Docetaxel + antracycline Paclitaxel + antracycline Paclitaxel + antracycline tegafur tegafur Target Preferable standart (A) standart (B) «А» Target Capecitabine + Without Capecitabine Capecitabine + Without Without «B» Capecitabine Capecitabine, Platinum agents Capecitabine, Platinum agents +
45 Systemic treament of metastatic breast cancer (ER/PgR negative HER2 positive) (Tab.16) Postmenopause continue Prof.V.F.Semiglazov, R.M.Paltuev., A.G.Manichas, Prof. R.V.Orlova 2013 time less then 5 years. B. Visceral C. Clinical manifestations Previous capecitabine capecitabine capecitabine +drugs from «A» and «B» columns Target Preferable standart (A) Without If not used in privious regimens: standart (B) Vinorelbine Vinorelbine If not used in privious regimens Vinorelbine or Change Taxane regimen «А» + + Target «B» 43
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