Last reviewed: November 2017
Last updated: November  2017

Important updates

New analysis shows trastuzumab survival benefit

  • New analysis of data from the EMILIA trial showed that trastuzumab emtansine improved overall survival compared with lapatinib plus capecitabine in patients with HER2-positive unresectable, locally advanced or metastatic breast cancer previously treated with trastuzumab and a taxane.

See Management: approach

Original source of update

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • bone pain
  • palpable mass after treatment of the primary
  • pleural effusion

Other diagnostic factors

  • shortness of breath
  • anorexia
  • weight loss
  • neurological pain or weakness, headaches, seizures

Risk factors

  • female sex
  • age >50 years
  • family history of breast and/or ovarian cancer
  • BRCA1 (breast cancer type 1, early onset) or BRCA2 (breast cancer type 2 susceptibility protein) mutation present in either parent
  • PALB2 germline mutations
  • tumour >5 cm in diameter
  • high number of positive nodes (e.g., >10)
  • lymphovascular invasion
  • unfavourable 70-gene signature
  • high-risk 21-gene signature
  • CDH1 germline mutations
  • minimal residual disease (MRD)
  • bone metastasis and lung metastasis gene signatures
  • Lynch family syndrome
  • CHEK2 mutations
  • ATM mutations

Diagnostic investigations

1st investigations to order

  • FBC
  • LFTs
  • calcium
  • CXR
  • CT (of chest and abdomen)
  • bone scan
Full details

Investigations to consider

  • MRI (focused on area of concern; e.g., bone, brain)
  • PET scan
  • biopsy of metastatic lesion
  • MUGA (multi-gated acquisitional) scan
  • pleural cytology
  • carcinoembryonic antigen
  • cancer antigen 15-3
  • cancer antigen 27-29
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Edward Sauter

Director

Breast Surgery Program

Hartford Healthcare

Hartford

Visiting Professor of Surgery

University of Connecticut School of Medicine

Farmington

CT

Disclosures

ES declares that he has no competing interests.

Hematology and Oncology

Ellis Fischel Cancer Center

Margaret Proctor Mulligan Assistant Professor of Clinical Medicine

Medical Oncology - Breast Program Director

University of Missouri

Columbia

MO

Disclosures

PN declares that she has no competing interests.

Professor

Clinical Medicine

University of Missouri

Columbia

MO

Disclosures

Not disclosed.

Dr Edward Sauter, Dr Puja Nistala, and Dr Donald Doll would like to gratefully acknowledge Dr Carl E. Freter and Dr Michael Perry, the previous contributors to this monograph.

Disclosures

CEF and MP declare that they have no competing interests.

Peer reviewers VIEW ALL

Professor

Assistant Dean

Undergraduate Program

McMaster University

Hamilton

Ontario

Canada

Disclosures

AN declares that he has no competing interests.

Consultant

Honorary Senior Lecturer in Medical Oncology

South West Wales Cancer Centre

Swansea

UK

Disclosures

GB has received honoraria for participation in advisory boards (AstraZeneca, Novartis, Pfizer, Roche, GSK, Cephalon, Amgen, Sanofi, Aventis), speaker's fees (AstraZeneca, Novartis, Sanofi, Aventis), and hospitality at conferences (AstraZeneca, Novartis, Pfizer, Roche, Aventis).

Assistant Professor

Division of Hematology/Oncology

Department of Medicine

University of Alabama at Birmingham

Birmingham

AL

Disclosures

CV declares that University of Alabama at Birmingham has received research support from Pfizer, F. Hoffmann-La Roche, and Incyte.

Use of this content is subject to our disclaimer