Precautions for Premenopausal Breast Cancer Patients

1. The standard treatment of HR +/HER2-advanced breast cancer recommended by current guidelines: HR +/HER2-recurrent and metastatic breast cancer after menopause. Or the first-line preferred regimen for systemic therapy in premenopausal patients undergoing ovariectomy/functional suppression: AI + CDK4/6 inhibitors (rebosilide primary recommendation/abecilide/piperacilide) fulvestrant + CDK4/6 inhibitors ER +/HER2- ET + CDK4/6 inhibitors are the first-line preferred regimens for metastatic breast cancer (Premenopausal patients combined with OFS) HR +/HER2- Advanced or metastatic breast cancer first-line preferred AI/fulvestrant + CDK4/6 inhibitors (Premenopausal patients combined with OFS) Hormone receptor-positive advanced breast cancer rescue endocrine therapy Patients without endocrine therapy: AI + CDK4/6 inhibitors (Level I recommendation) AI (Grade II recommendation) Fulvestrant (Grade II recommendation) Fulvestrant + CDK4/6 inhibitors (Grade II recommendation) Treatment of HR-positive HER2-negative advanced breast cancer Patients without visceral crisis should be given preference to CDK4/6 inhibitors in combination with endocrine drugs. It is suggested that patients with ER positive and (or) PR positive before menopause should be referred to the treatment options of postmenopausal patients after castration. Aromatase inhibitors in combination with CDK4/6 inhibitors are the first-line endocrine treatment of choice for patients with breast cancer who are either postmenopausal (natural menopause or surgical castration) or premenopausal but medically castrated. It should be noted that the standard treatment options for HR +/HER2- advanced breast cancer recommended by major guidelines usually include endocrine therapy and CDK4/6 inhibitors. However, it should be noted that chemotherapy is still an indispensable traditional treatment for advanced breast cancer. The choice of different treatment options should fully consider the wishes of patients and the characteristics of the disease, and be discussed and decided by doctors and patients on the premise of balancing the quality of life and survival time. Those who completed the regimen had a higher chance of survival than those who did not. Most treatment-related adverse reactions occur in the early stage of treatment. Please do not be overly nervous. These adverse events can be effectively controlled through good adverse reaction management and medication adjustment. If adverse reactions occur, please communicate with the doctor in time, and do not stop or reduce the dosage on your own. 2. Endocrine therapy represents adverse drug reactions and response: facial flushing, fatigue: relax, with the extension of medication time will gradually improve joint pain: excluding other diseases, when the symptoms are serious, non-steroidal anti-inflammatory analgesics can be used appropriately for symptomatic treatment of osteoporosis: annual detection of bone mineral density, calcium supplementation and vitamin D, more sunshine. Proper exercise, menstrual disorders, facial flushing, rash, dyslipidemia, liver function damage, can be alleviated after treatment. The risk of thrombosis is relatively high. Long-term use (especially for more than 5 years) can cause endometrial hyperplasia, although there is a risk of endometrial cancer, but it rarely occurs (10-year incidence < 1%); The most common adverse reactions were injection site reaction, weakness, nausea and liver enzyme (ALT, AST, ALP) elevation. If there is pain at the injection site, local hot compress can be considered to relieve it, and painkillers can be taken if necessary. During treatment, contraception should be paid attention to, and liver function and bone mineral density should be reexamined regularly without breast-feeding.