Hormonal Therapy for Postmenopausal HR+, HER2- MBC Patients

Recently there have been media announcements about newly approved hormonal therapy drugs and combinations for postmenopausal hormone receptor positive, HER2 negative MBC patients. Sometimes the drugs are newly approved together as a combination; other times they are newly approved for a specific "line" of treatment (i.e. as a first line [initial] therapy, or as a second line therapy after the first line therapy failed).

Due to the volume of new approvals for these drugs in the US, Canada, and Europe, I looked for a website where patients could obtain consolidated, up-to-date information about what hormonal therapies are available to them (by location) and when. After not finding anything even remotely helpful, I took the plunge and pieced it together as best I could. The results are provided below, and this information has also been incorporated in my MBC Guide.

That said, it's possible that I've made an error (especially with regard to approved therapies for patients in Canada in Europe) so it's always best to check with your doctor.

I truly hope that this list will be helpful.

Hugs to all.

The sequence of providing hormonal (endocrine) therapy for postmenopausal patients will vary, as much of it depends upon what - if any - hormonal therapy drugs the patient has previously taken and how recently they were administered. The sequence will also depend upon the country in which the patient resides.

Generally, there is a choice of providing single drugs or a combination of drugs, with combination drugs generally precipitating more side effects. Patients are urged to discuss the various options with their doctor and to verify insurance coverage, since it is possible that some of the combination drug regimens listed below may not yet be covered by insurance.

FOR POSTMENOPAUSAL HORMONE RECEPTOR POSITIVE, HER2 NEGATIVE MBC PATIENTS IN THE US (Updated Nov. 2017):

First line Treatment Options (depending upon what, if any, recent treatments the patient may have had in the adjuvant setting):
* Letrozole alone
* Arimidex alone
* Aromasin alone
* Faslodex alone
* Letrozole and IBRANCE
* Letrozole and Kisqali
* Arimidex and IBRANCE
* Arimidex and Kisqali
* Aromasin and IBRANCE
* Aromasin and Kisqali

Second line Treatment Options (depending upon prior treatment):
* Letrozole alone
* Arimidex alone
* Aromasin alone
* Faslodex alone
* Letrozole and IBRANCE

* Faslodex and Verzenio (Abemaciclib)

* Verzenio (Abemaciclib) Alone (If the patient already underwent hormonal therapy AND chemotherapy that failed)
* Faslodex and IBRANCE
* Aromasin and Afinitor

Third line Treatment Options (depending upon prior treatments):
* Possibly any of the above therapies (although not all combinations are widely used in a third-line setting)
* Tamoxifen or Fareston

Fourth line Treatment Options (depending upon prior treatments):
* Possibly any of the above therapies (although not all combinations are widely used in a fourth-line setting)
* Either Estradiol, Megestrol Acetate (Megace), or Halotestin (Fluoxymesterone)

FOR POSTMENOPAUSAL HORMONE RECEPTOR POSITIVE, HER2 NEGATIVE MBC PATIENTS IN CANADA:

First line Treatment Options (depending upon what, if any, recent treatments the patient may have had in the adjuvant setting):
* Letrozole alone
* Arimidex alone
* Aromasin alone
* Letrozole and IBRANCE

Second line Treatment Options (depending upon prior treatment):
* Letrozole alone
* Arimidex alone
* Aromasin alone
* Faslodex alone
* Faslodex and IBRANCE
* Aromasin and Afinitor
(I was unable to locate specific information about approved third and fourth line therapies for Canadian patients, although it is likely that Tamoxifen would be a third line candidate, after which Megace may be a fourth line option ).

FOR POSTMENOPAUSAL HORMONE RECEPTOR POSITIVE, HER2 NEGATIVE MBC PATIENTS IN EUROPE:

First line Treatment Options (depending upon what, if any, recent treatments the patient may have had in the adjuvant setting):
* Letrozole alone
* Arimidex alone
* Aromasin alone
* Faslodex alone
* Letrozole and IBRANCE
* Letrozole and Kisqali
* Arimidex and IBRANCE
* Arimidex and Kisqali
* Aromasin and IBRANCE
* Aromasin and Kisqali

Second line Treatment Options (depending upon prior treatment):
* Letrozole alone
* Arimidex alone
* Aromasin alone
* Faslodex alone
* Faslodex and IBRANCE
* Aromasin and Afinitor
(I was unable to locate specific information about approved third and fourth line therapies for European patients, although it is likely that Tamoxifen would be a third line candidate, after which Megace may be a fourth line option ).