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Section editor transclusions Note: these are regimens tested in patients with hormone receptor-positive, HER2-positive breast cancer. Please see the main breast cancer page, ER+ breast cancer page, and HER2+ breast cancer page for other regimens.

19 regimens on this page 21 variants on this page

Neoadjuvant chemotherapy

Trastuzumab emtansine monotherapy

T-DM1: Trastuzumab-DM1 (Trastuzumab emtansine)

Regimen

Study	Years of enrollment	Evidence	Comparator	Comparative Efficacy
Harbeck et al. 2017 (WGSG ADAPT)	2012-2015	Randomized Phase 2 (E-switch-ic)	1. T-DM1 & ET	Not reported
Harbeck et al. 2017 (WGSG ADAPT)	2012-2015	Randomized Phase 2 (E-switch-ic)	2. Trastuzumab & ET	Superior pCR rate

Antibody-drug conjugate therapy

Trastuzumab emtansine (Kadcyla) 3.6 mg/kg IV once on day 1

21-day cycle for 4 cycles

Subsequent treatment

Surgery was performed within 3 weeks of the end of therapy. Adjuvant therapy consisted of EC, then TH (Paclitaxel), unless the patient had pCR in which case adjuvant therapy was optional

References

WGSG ADAPT: Harbeck N, Gluz O, Christgen M, Kates RE, Braun M, Küemmel S, Schumacher C, Potenberg J, Kraemer S, Kleine-Tebbe A, Augustin D, Aktas B, Forstbauer H, Tio J, von Schumann R, Liedtke C, Grischke EM, Schumacher J, Wuerstlein R, Kreipe HH, Nitz UA; West German Study Group. De-escalation strategies in human epidermal growth factor receptor 2 (HER2)-positive early breast cancer (BC): Final analysis of the West German Study Group Adjuvant Dynamic marker-Adjusted Personalized Therapy trial optimizing risk assessment and therapy response prediction in early BC HER2- and hormone receptor-positive phase II randomized trial-efficacy, safety, and predictive markers for 12 weeks of neoadjuvant trastuzumab emtansine with or without endocrine therapy (ET) versus trastuzumab plus ET. J Clin Oncol. 2017 Sep 10;35(26):3046-3054. Epub 2017 Jul 6. link to original article contains dosing details in manuscript PubMed NCT01817452

T-DM1 & ET

T-DM1 & ET: Trastuzumab-DM1 (Trastuzumab emtansine) & Endocrine Therapy

Regimen

Study	Years of enrollment	Evidence	Comparator	Comparative Efficacy
Harbeck et al. 2017 (WGSG ADAPT)	2012-2015	Randomized Phase 2 (E-esc)	1. T-DM1	Not reported
Harbeck et al. 2017 (WGSG ADAPT)	2012-2015	Randomized Phase 2 (E-esc)	2. Trastuzumab & ET	Superior pCR rate

Antibody-drug conjugate therapy

Trastuzumab emtansine (Kadcyla) 3.6 mg/kg IV once on day 1

Endocrine therapy

One of the following:
- Premenopausal women: Tamoxifen (Nolvadex) recommended
- GnRH analogs were also allowed
- Postmenopausal women: Aromatase inhibitor recommended

21-day cycle for 4 cycles

Subsequent treatment

Surgery was performed within 3 weeks of the end of therapy. Adjuvant therapy consisted of EC, then TH (Paclitaxel), unless the patient had pCR in which case adjuvant therapy was optional

References

WGSG ADAPT: Harbeck N, Gluz O, Christgen M, Kates RE, Braun M, Küemmel S, Schumacher C, Potenberg J, Kraemer S, Kleine-Tebbe A, Augustin D, Aktas B, Forstbauer H, Tio J, von Schumann R, Liedtke C, Grischke EM, Schumacher J, Wuerstlein R, Kreipe HH, Nitz UA; West German Study Group. De-escalation strategies in human epidermal growth factor receptor 2 (HER2)-positive early breast cancer (BC): Final analysis of the West German Study Group Adjuvant Dynamic marker-Adjusted Personalized Therapy trial optimizing risk assessment and therapy response prediction in early BC HER2- and hormone receptor-positive phase II randomized trial-efficacy, safety, and predictive markers for 12 weeks of neoadjuvant trastuzumab emtansine with or without endocrine therapy (ET) versus trastuzumab plus ET. J Clin Oncol. 2017 Sep 10;35(26):3046-3054. Epub 2017 Jul 6. link to original article contains dosing details in manuscript PubMed NCT01817452

Trastuzumab & ET

Trastuzumab & ET: Trastuzumab & Endocrine Therapy

Regimen

Study	Years of enrollment	Evidence	Comparator	Comparative Efficacy
Harbeck et al. 2017 (WGSG ADAPT)	2012-2015	Randomized Phase 2 (C)	1. T-DM1 2. T-DM1 & ET	Inferior pCR rate

Targeted therapy

Trastuzumab (Herceptin) as follows:
- Cycle 1: 8 mg/kg IV once on day 1
- Cycles 2 to 4: 6 mg/kg IV once on day 1

Endocrine therapy

Endocrine therapy by the following criteria:
- Premenopausal women: Tamoxifen (Nolvadex) recommended
  - GnRH analogs were also allowed
- Postmenopausal women: Aromatase inhibitor recommended

21-day cycle for 4 cycles

Subsequent treatment

Surgery was performed within 3 weeks of the end of therapy. Adjuvant therapy consisted of EC, then TH (Paclitaxel), unless the patient had pCR in which case adjuvant therapy was optional

References

WGSG ADAPT: Harbeck N, Gluz O, Christgen M, Kates RE, Braun M, Küemmel S, Schumacher C, Potenberg J, Kraemer S, Kleine-Tebbe A, Augustin D, Aktas B, Forstbauer H, Tio J, von Schumann R, Liedtke C, Grischke EM, Schumacher J, Wuerstlein R, Kreipe HH, Nitz UA; West German Study Group. De-escalation strategies in human epidermal growth factor receptor 2 (HER2)-positive early breast cancer (BC): Final analysis of the West German Study Group Adjuvant Dynamic marker-Adjusted Personalized Therapy trial optimizing risk assessment and therapy response prediction in early BC HER2- and hormone receptor-positive phase II randomized trial-efficacy, safety, and predictive markers for 12 weeks of neoadjuvant trastuzumab emtansine with or without endocrine therapy (ET) versus trastuzumab plus ET. J Clin Oncol. 2017 Sep 10;35(26):3046-3054. Epub 2017 Jul 6. link to original article contains dosing details in manuscript PubMed NCT01817452

Adjuvant therapy

Anastrozole monotherapy

Regimen

Study	Years of enrollment	Evidence	Comparator	Comparative Efficacy
Awaiting publication (eMonarcHER)	2021-ongoing	Phase 3 (C)	ET & Abemaciclib	In progress

Preceding treatment

HER2-targeted therapy

Endocrine therapy

Anastrozole (Arimidex) 1 mg PO once per day

Continued for up to 10 years

References

eMonarcHER: NCT04752332

Metastatic disease, first-line therapy

Anastrozole monotherapy

Regimen

Study	Years of enrollment	Evidence	Comparator	Comparative Efficacy
Kaufman et al. 2009 (TAnDEM)	2001-2004	Phase 3 (C)	Anastrozole & Trastuzumab	Inferior PFS

Endocrine therapy

Anastrozole (Arimidex) 1 mg PO once per day

28-day cycles

References

TAnDEM: Kaufman B, Mackey JR, Clemens MR, Bapsy PP, Vaid A, Wardley A, Tjulandin S, Jahn M, Lehle M, Feyereislova A, Révil C, Jones A. Trastuzumab plus anastrozole versus anastrozole alone for the treatment of postmenopausal women with human epidermal growth factor receptor 2-positive, hormone receptor-positive metastatic breast cancer: results from the randomized phase III TAnDEM study. J Clin Oncol. 2009 Nov 20;27(33):5529-37. Epub 2009 Sep 28. link to original article contains dosing details in abstract PubMed NCT00022672

Anastrozole & Trastuzumab

Regimen variant #1, weekly trastuzumab

Study	Years of enrollment	Evidence	Comparator	Comparative Efficacy
Kaufman et al. 2009 (TAnDEM)	2001-2004	Phase 3 (E-esc)	Anastrozole	Superior PFS Median PFS: 4.8 vs 2.4 mo (HR 0.63, 95% CI 0.47-0.84)

Endocrine therapy

Anastrozole (Arimidex) 1 mg PO once per day

Targeted therapy

Trastuzumab (Herceptin) as follows:
- Cycle 1: 4 mg/kg IV once on day 1, then 2 mg/kg IV once per day on days 8, 15, 22
- Cycle 2 onwards: 2 mg/kg IV once per day on days 1, 8, 15, 22

28-day cycles

Regimen variant #2, q3wk trastuzumab

Study	Years of enrollment	Evidence	Comparator	Comparative Efficacy
Johnston et al. 2020 (ALTERNATIVE)	2011-2016	Phase 3 (C)	1. Anastrozole & Lapatinib 2. Exemestane & Lapatinib 3. Lapatinib & Letrozole	Did not meet secondary endpoint of PFS
Johnston et al. 2020 (ALTERNATIVE)	2011-2016	Phase 3 (C)	4. Anastrozole, Lapatinib, Trastuzumab 5. Exemestane, Lapatinib, Trastuzumab 6. Lapatinib, Letrozole, Trastuzumab	Inferior PFS
Hua et al. 2022 (SYSUCC-002)	2013-2019	Phase 3 (E-switch-ooc)	1. TH (Paclitaxel) 2. TH (Docetaxel) 3. VH; IV 4. VH; PO 5. XH	Non-Inferior PFS Median PFS: 19.2 vs 14.8 mo (HR 0.88, 95% CI 0.71-1.09)

Note: the original ALTERNATIVE article published in 2018 was retracted due to numeric errors in the analysis, and an update has been published. Hua et al. 2022 does not contain dosing instructions for anastrozole.

Targeted therapy

Trastuzumab (Herceptin) as follows:
- Cycle 1: 8 mg/kg IV once on day 1
- Cycle 2 onwards: 6 mg/kg IV once on day 1

Endocrine therapy

Anastrozole (Arimidex) 1 mg PO once per day

21-day cycles

References

TAnDEM: Kaufman B, Mackey JR, Clemens MR, Bapsy PP, Vaid A, Wardley A, Tjulandin S, Jahn M, Lehle M, Feyereislova A, Révil C, Jones A. Trastuzumab plus anastrozole versus anastrozole alone for the treatment of postmenopausal women with human epidermal growth factor receptor 2-positive, hormone receptor-positive metastatic breast cancer: results from the randomized phase III TAnDEM study. J Clin Oncol. 2009 Nov 20;27(33):5529-37. Epub 2009 Sep 28. link to original article contains dosing details in abstract PubMed NCT00022672
ALTERNATIVE: Johnston SRD, Hegg R, Im SA, Park IH, Burdaeva O, Kurteva G, Press MF, Tjulandin S, Iwata H, Simon SD, Kenny S, Sarp S, Izquierdo MA, Williams LS, Gradishar WJ. Phase III, Randomized Study of Dual Human Epidermal Growth Factor Receptor 2 (HER2) Blockade With Lapatinib Plus Trastuzumab in Combination With an Aromatase Inhibitor in Postmenopausal Women With HER2-Positive, Hormone Receptor-Positive Metastatic Breast Cancer: Updated Results of ALTERNATIVE. J Clin Oncol. 2021 Jan 1;39(1):79-89. Epub 2020 Aug 21. link to original article contains dosing details in manuscript PubMed NCT01160211
SYSUCC-002: Hua X, Bi XW, Zhao JL, Shi YX, Lin Y, Wu ZY, Zhang YQ, Zhang LH, Zhang AQ, Huang H, Liu XM, Xu F, Guo Y, Xia W, Hong RX, Jiang KK, Xue C, An X, Zhong YY, Wang SS, Huang JJ, Yuan ZY. Trastuzumab Plus Endocrine Therapy or Chemotherapy as First-line Treatment for Patients with Hormone Receptor-Positive and HER2-Positive Metastatic Breast Cancer (SYSUCC-002). Clin Cancer Res. 2022 Feb 15;28(4):637-645. link to original article contains partial protocol PubMed NCT01950182

Anastrozole, Lapatinib, Trastuzumab

Regimen

Study	Years of enrollment	Evidence	Comparator	Comparative Efficacy
Johnston et al. 2020 (ALTERNATIVE)	2011-2016	Phase 3 (E-esc)	1. Anastrozole & Lapatinib 2. Exemestane & Lapatinib 3. Lapatinib & Letrozole	Not reported
Johnston et al. 2020 (ALTERNATIVE)	2011-2016	Phase 3 (E-esc)	4. Anastrozole & Trastuzumab 5. Exemestane & Trastuzumab 6. Letrozole & Trastuzumab	Superior PFS Median PFS: 11 vs 5.6 mo (HR 0.62, 95% CI 0.45-0.88)

Note: the original article published in 2018 was retracted due to numeric errors in the analysis, and an update has been published.

Targeted therapy

Lapatinib (Tykerb) 1000 mg PO once per day
Trastuzumab (Herceptin) as follows:
- Cycle 1: 8 mg/kg IV once on day 1
- Cycle 2 onwards: 6 mg/kg IV once on day 1

Endocrine therapy

Anastrozole (Arimidex) 1 mg PO once per day

21-day cycles

References

ALTERNATIVE: Johnston SRD, Hegg R, Im SA, Park IH, Burdaeva O, Kurteva G, Press MF, Tjulandin S, Iwata H, Simon SD, Kenny S, Sarp S, Izquierdo MA, Williams LS, Gradishar WJ. Phase III, Randomized Study of Dual Human Epidermal Growth Factor Receptor 2 (HER2) Blockade With Lapatinib Plus Trastuzumab in Combination With an Aromatase Inhibitor in Postmenopausal Women With HER2-Positive, Hormone Receptor-Positive Metastatic Breast Cancer: Updated Results of ALTERNATIVE. J Clin Oncol. 2021 Jan 1;39(1):79-89. Epub 2020 Aug 21. link to original article contains dosing details in manuscript PubMed NCT01160211

Exemestane & Trastuzumab

Regimen

Study	Years of enrollment	Evidence	Comparator	Comparative Efficacy
Johnston et al. 2020 (ALTERNATIVE)	2011-2016	Phase 3 (C)	1. Anastrozole & Lapatinib 2. Exemestane & Lapatinib 3. Lapatinib & Letrozole	Did not meet secondary endpoint of PFS
Johnston et al. 2020 (ALTERNATIVE)	2011-2016	Phase 3 (C)	4. Anastrozole, Lapatinib, Trastuzumab 5. Exemestane, Lapatinib, Trastuzumab 6. Lapatinib, Letrozole, Trastuzumab	Inferior PFS
Hua et al. 2022 (SYSUCC-002)	2013-2019	Phase 3 (E-switch-ooc)	1. TH (Paclitaxel) 2. TH (Docetaxel) 3. VH; IV 4. VH; PO 5. XH	Non-Inferior PFS Median PFS: 19.2 vs 14.8 mo (HR 0.88, 95% CI 0.71-1.09)

Note: the original ALTERNATIVE article published in 2018 was retracted due to numeric errors in the analysis, and an update has been published. Hua et al. 2022 does not contain dosing instructions for exemestane.

Targeted therapy

Trastuzumab (Herceptin) as follows:
- Cycle 1: 8 mg/kg IV once on day 1
- Cycle 2 onwards: 6 mg/kg IV once on day 1

Endocrine therapy

Exemestane (Aromasin) 1 mg PO once per day

21-day cycles

References

ALTERNATIVE: Johnston SRD, Hegg R, Im SA, Park IH, Burdaeva O, Kurteva G, Press MF, Tjulandin S, Iwata H, Simon SD, Kenny S, Sarp S, Izquierdo MA, Williams LS, Gradishar WJ. Phase III, Randomized Study of Dual Human Epidermal Growth Factor Receptor 2 (HER2) Blockade With Lapatinib Plus Trastuzumab in Combination With an Aromatase Inhibitor in Postmenopausal Women With HER2-Positive, Hormone Receptor-Positive Metastatic Breast Cancer: Updated Results of ALTERNATIVE. J Clin Oncol. 2021 Jan 1;39(1):79-89. Epub 2020 Aug 21. link to original article contains dosing details in manuscript PubMed NCT01160211
SYSUCC-002: Hua X, Bi XW, Zhao JL, Shi YX, Lin Y, Wu ZY, Zhang YQ, Zhang LH, Zhang AQ, Huang H, Liu XM, Xu F, Guo Y, Xia W, Hong RX, Jiang KK, Xue C, An X, Zhong YY, Wang SS, Huang JJ, Yuan ZY. Trastuzumab Plus Endocrine Therapy or Chemotherapy as First-line Treatment for Patients with Hormone Receptor-Positive and HER2-Positive Metastatic Breast Cancer (SYSUCC-002). Clin Cancer Res. 2022 Feb 15;28(4):637-645. link to original article contains partial protocol PubMed NCT01950182

Exemestane, Lapatinib, Trastuzumab

Regimen

Study	Years of enrollment	Evidence	Comparator	Comparative Efficacy
Johnston et al. 2020 (ALTERNATIVE)	2011-2016	Phase 3 (E-esc)	1. Anastrozole & Lapatinib 2. Exemestane & Lapatinib 3. Lapatinib & Letrozole	Not reported
Johnston et al. 2020 (ALTERNATIVE)	2011-2016	Phase 3 (E-esc)	4. Anastrozole & Trastuzumab 5. Exemestane & Trastuzumab 6. Letrozole & Trastuzumab	Superior PFS Median PFS: 11 vs 5.6 mo (HR 0.62, 95% CI 0.45-0.88)

Note: the original article published in 2018 was retracted due to numeric errors in the analysis, and an update has been published.

Targeted therapy

Lapatinib (Tykerb) 1000 mg PO once per day
Trastuzumab (Herceptin) as follows:
- Cycle 1: 8 mg/kg IV once on day 1
- Cycle 2 onwards: 6 mg/kg IV once on day 1

Endocrine therapy

Exemestane (Aromasin) 25 mg PO once per day

21-day cycles

References

ALTERNATIVE: Johnston SRD, Hegg R, Im SA, Park IH, Burdaeva O, Kurteva G, Press MF, Tjulandin S, Iwata H, Simon SD, Kenny S, Sarp S, Izquierdo MA, Williams LS, Gradishar WJ. Phase III, Randomized Study of Dual Human Epidermal Growth Factor Receptor 2 (HER2) Blockade With Lapatinib Plus Trastuzumab in Combination With an Aromatase Inhibitor in Postmenopausal Women With HER2-Positive, Hormone Receptor-Positive Metastatic Breast Cancer: Updated Results of ALTERNATIVE. J Clin Oncol. 2021 Jan 1;39(1):79-89. Epub 2020 Aug 21. link to original article contains dosing details in manuscript PubMed NCT01160211

Lapatinib & Letrozole

Regimen

Study	Years of enrollment	Evidence	Comparator	Comparative Efficacy
Johnston et al. 2009 (EGF30008)	2003-2006	Phase 3 (E-RT-esc)	Letrozole	Seems to have superior PFS Median PFS: 8.2 vs 3 mo (HR 0.71, 95% CI 0.53-0.96)

Targeted therapy

Lapatinib (Tykerb) 1500 mg PO once per day

Endocrine therapy

Letrozole (Femara) 2.5 mg PO once per day

Continued indefinitely

References

EGF30008: Johnston S, Pippen J Jr, Pivot X, Lichinitser M, Sadeghi S, Dieras V, Gomez HL, Romieu G, Manikhas A, Kennedy MJ, Press MF, Maltzman J, Florance A, O'Rourke L, Oliva C, Stein S, Pegram M. Lapatinib combined with letrozole versus letrozole and placebo as first-line therapy for postmenopausal hormone receptor-positive metastatic breast cancer. J Clin Oncol. 2009 Nov 20;27(33):5538-46. Epub 2009 Sep 28. link to original article contains dosing details in abstract PubMed NCT00073528

Lapatinib, Letrozole, Trastuzumab

Regimen

Study	Years of enrollment	Evidence	Comparator	Comparative Efficacy
Johnston et al. 2020 (ALTERNATIVE)	2011-2016	Phase 3 (E-esc)	1. Anastrozole & Lapatinib 2. Exemestane & Lapatinib 3. Lapatinib & Letrozole	Not reported
Johnston et al. 2020 (ALTERNATIVE)	2011-2016	Phase 3 (E-esc)	4. Anastrozole & Trastuzumab 5. Exemestane & Trastuzumab 6. Letrozole & Trastuzumab	Superior PFS Median PFS: 11 vs 5.6 mo (HR 0.62, 95% CI 0.45-0.88)

Note: the original article published in 2018 was retracted due to numeric errors in the analysis, and an update has been published.

Targeted therapy

Lapatinib (Tykerb) 1000 mg PO once per day
Trastuzumab (Herceptin) as follows:
- Cycle 1: 8 mg/kg IV once on day 1
- Cycle 2 onwards: 6 mg/kg IV once on day 1

Endocrine therapy

Letrozole (Femara) 2.5 mg PO once per day

21-day cycles

References

ALTERNATIVE: Johnston SRD, Hegg R, Im SA, Park IH, Burdaeva O, Kurteva G, Press MF, Tjulandin S, Iwata H, Simon SD, Kenny S, Sarp S, Izquierdo MA, Williams LS, Gradishar WJ. Phase III, Randomized Study of Dual Human Epidermal Growth Factor Receptor 2 (HER2) Blockade With Lapatinib Plus Trastuzumab in Combination With an Aromatase Inhibitor in Postmenopausal Women With HER2-Positive, Hormone Receptor-Positive Metastatic Breast Cancer: Updated Results of ALTERNATIVE. J Clin Oncol. 2021 Jan 1;39(1):79-89. Epub 2020 Aug 21. link to original article contains dosing details in manuscript PubMed NCT01160211

Letrozole monotherapy

Regimen

Study	Years of enrollment	Evidence	Comparator	Comparative Efficacy
Johnston et al. 2009 (EGF30008)	2003-2006	Phase 3 (C)	Lapatinib & Letrozole	Seems to have inferior PFS

Endocrine therapy

Letrozole (Femara) 2.5 mg PO once per day

28-day cycles

References

EGF30008: Johnston S, Pippen J Jr, Pivot X, Lichinitser M, Sadeghi S, Dieras V, Gomez HL, Romieu G, Manikhas A, Kennedy MJ, Press MF, Maltzman J, Florance A, O'Rourke L, Oliva C, Stein S, Pegram M. Lapatinib combined with letrozole versus letrozole and placebo as first-line therapy for postmenopausal hormone receptor-positive metastatic breast cancer. J Clin Oncol. 2009 Nov 20;27(33):5538-46. Epub 2009 Sep 28. link to original article contains dosing details in abstract PubMed NCT00073528

Letrozole & Trastuzumab

Regimen

Study	Years of enrollment	Evidence	Comparator	Comparative Efficacy
Johnston et al. 2020 (ALTERNATIVE)	2011-2016	Phase 3 (C)	1. Anastrozole & Lapatinib 2. Exemestane & Lapatinib 3. Lapatinib & Letrozole	Did not meet secondary endpoint of PFS
Johnston et al. 2020 (ALTERNATIVE)	2011-2016	Phase 3 (C)	4. Anastrozole, Lapatinib, Trastuzumab 5. Exemestane, Lapatinib, Trastuzumab 6. Lapatinib, Letrozole, Trastuzumab	Inferior PFS
Hua et al. 2022 (SYSUCC-002)	2013-2019	Phase 3 (E-switch-ooc)	1. TH (Paclitaxel) 2. TH (Docetaxel) 3. VH; IV 4. VH; PO 5. XH	Non-Inferior PFS Median PFS: 19.2 vs 14.8 mo (HR 0.88, 95% CI 0.71-1.09)

Note: the original ALTERNATIVE article published in 2018 was retracted due to numeric errors in the analysis, and an update has been published. Hua et al. does not contain dosing instructions for letrozole.

Targeted therapy

Trastuzumab (Herceptin) as follows:
- Cycle 1: 8 mg/kg IV once on day 1
- Cycle 2 onwards: 6 mg/kg IV once on day 1

Endocrine therapy

Letrozole (Femara) 2.5 mg PO once per day

21-day cycles

References

ALTERNATIVE: Johnston SRD, Hegg R, Im SA, Park IH, Burdaeva O, Kurteva G, Press MF, Tjulandin S, Iwata H, Simon SD, Kenny S, Sarp S, Izquierdo MA, Williams LS, Gradishar WJ. Phase III, Randomized Study of Dual Human Epidermal Growth Factor Receptor 2 (HER2) Blockade With Lapatinib Plus Trastuzumab in Combination With an Aromatase Inhibitor in Postmenopausal Women With HER2-Positive, Hormone Receptor-Positive Metastatic Breast Cancer: Updated Results of ALTERNATIVE. J Clin Oncol. 2021 Jan 1;39(1):79-89. Epub 2020 Aug 21. link to original article contains dosing details in manuscript PubMed NCT01160211
SYSUCC-002: Hua X, Bi XW, Zhao JL, Shi YX, Lin Y, Wu ZY, Zhang YQ, Zhang LH, Zhang AQ, Huang H, Liu XM, Xu F, Guo Y, Xia W, Hong RX, Jiang KK, Xue C, An X, Zhong YY, Wang SS, Huang JJ, Yuan ZY. Trastuzumab Plus Endocrine Therapy or Chemotherapy as First-line Treatment for Patients with Hormone Receptor-Positive and HER2-Positive Metastatic Breast Cancer (SYSUCC-002). Clin Cancer Res. 2022 Feb 15;28(4):637-645. link to original article contains partial protocol PubMed NCT01950182

@@ Line 11: / Line 11: @@
 |}
 {{TOC limit|limit=3}}
 =Neoadjuvant chemotherapy=
 ==Trastuzumab emtansine monotherapy {{#subobject:ef98f0|Regimen=1}}==
 T-DM1: '''<u>T</u>'''rastuzumab-'''<u>DM1</u>''' (Trastuzumab emtansine)
+<div class="toccolours" style="background-color:#eeeeee">
 ===Regimen {{#subobject:91b517|Variant=1}}===
 {| class="wikitable sortable" style="width: 100%; text-align:center;"
@@ Line 34: / Line 33: @@
 |-
 |}
+<div class="toccolours" style="background-color:#b3e2cd">
 ====Antibody-drug conjugate therapy====
 *[[Trastuzumab emtansine (Kadcyla)]] 3.6 mg/kg IV once on day 1
 '''21-day cycle for 4 cycles'''
+</div>
+<div class="toccolours" style="background-color:#cbd5e7">
 ====Subsequent treatment====
 *[[Surgery#Breast_cancer_surgery|Surgery]] was performed within 3 weeks of the end of therapy. Adjuvant therapy consisted of [[Breast_cancer#Cyclophosphamide_.26_Epirubicin_.28EC.29_2|EC]], then [[#Paclitaxel_.26_Trastuzumab_.28TH.29_2|TH (Paclitaxel)]], unless the patient had pCR in which case adjuvant therapy was optional
+</div></div>
 ===References===
 # '''WGSG ADAPT:''' Harbeck N, Gluz O, Christgen M, Kates RE, Braun M, Küemmel S, Schumacher C, Potenberg J, Kraemer S, Kleine-Tebbe A, Augustin D, Aktas B, Forstbauer H, Tio J, von Schumann R, Liedtke C, Grischke EM, Schumacher J, Wuerstlein R, Kreipe HH, Nitz UA; West German Study Group. De-escalation strategies in human epidermal growth factor receptor 2 (HER2)-positive early breast cancer (BC): Final analysis of the West German Study Group Adjuvant Dynamic marker-Adjusted Personalized Therapy trial optimizing risk assessment and therapy response prediction in early BC HER2- and hormone receptor-positive phase II randomized trial-efficacy, safety, and predictive markers for 12 weeks of neoadjuvant trastuzumab emtansine with or without endocrine therapy (ET) versus trastuzumab plus ET. J Clin Oncol. 2017 Sep 10;35(26):3046-3054. Epub 2017 Jul 6. [https://doi.org/10.1200/JCO.2016.71.9815 link to original article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/28682681 PubMed] NCT01817452
 ==T-DM1 & ET {{#subobject:207386|Regimen=1}}==
 T-DM1 & ET: '''<u>T</u>'''rastuzumab-DM1 (Trastuzumab emtansine) & '''<u>E</u>'''ndocrine '''<u>T</u>'''herapy
+<div class="toccolours" style="background-color:#eeeeee">
 ===Regimen {{#subobject:b28ce1|Variant=1}}===
 {| class="wikitable sortable" style="width: 100%; text-align:center;"
@@ Line 65: / Line 65: @@
 |-
 |}
+<div class="toccolours" style="background-color:#b3e2cd">
 ====Antibody-drug conjugate therapy====
 *[[Trastuzumab emtansine (Kadcyla)]] 3.6 mg/kg IV once on day 1
 ====Endocrine therapy====
 *One of the following:
@@ Line 73: / Line 73: @@
 **[[:Category:GnRH_agonists|GnRH analogs]] were also allowed
 **Postmenopausal women: [[:Category:Aromatase inhibitors|Aromatase inhibitor]] recommended
 '''21-day cycle for 4 cycles'''
+</div>
+<div class="toccolours" style="background-color:#cbd5e7">
 ====Subsequent treatment====
 *[[Surgery#Breast_cancer_surgery|Surgery]] was performed within 3 weeks of the end of therapy. Adjuvant therapy consisted of [[Breast_cancer#Cyclophosphamide_.26_Epirubicin_.28EC.29_2|EC]], then [[#Paclitaxel_.26_Trastuzumab_.28TH.29_2|TH (Paclitaxel)]], unless the patient had pCR in which case adjuvant therapy was optional
+</div></div>
 ===References===
 # '''WGSG ADAPT:''' Harbeck N, Gluz O, Christgen M, Kates RE, Braun M, Küemmel S, Schumacher C, Potenberg J, Kraemer S, Kleine-Tebbe A, Augustin D, Aktas B, Forstbauer H, Tio J, von Schumann R, Liedtke C, Grischke EM, Schumacher J, Wuerstlein R, Kreipe HH, Nitz UA; West German Study Group. De-escalation strategies in human epidermal growth factor receptor 2 (HER2)-positive early breast cancer (BC): Final analysis of the West German Study Group Adjuvant Dynamic marker-Adjusted Personalized Therapy trial optimizing risk assessment and therapy response prediction in early BC HER2- and hormone receptor-positive phase II randomized trial-efficacy, safety, and predictive markers for 12 weeks of neoadjuvant trastuzumab emtansine with or without endocrine therapy (ET) versus trastuzumab plus ET. J Clin Oncol. 2017 Sep 10;35(26):3046-3054. Epub 2017 Jul 6. [https://doi.org/10.1200/JCO.2016.71.9815 link to original article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/28682681 PubMed] NCT01817452
 ==Trastuzumab & ET {{#subobject:b9d62c|Regimen=1}}==
 Trastuzumab & ET: Trastuzumab & '''<u>E</u>'''ndocrine '''<u>T</u>'''herapy
+<div class="toccolours" style="background-color:#eeeeee">
 ===Regimen {{#subobject:d0233|Variant=1}}===
 {| class="wikitable sortable" style="width: 100%; text-align:center;"
@@ Line 99: / Line 99: @@
 |-
 |}
+<div class="toccolours" style="background-color:#b3e2cd">
 ====Targeted therapy====
 *[[Trastuzumab (Herceptin)]] as follows:
@@ Line 108: / Line 109: @@
 ***[[:Category:GnRH_agonists|GnRH analogs]] were also allowed
 **Postmenopausal women: [[:Category:Aromatase inhibitors|Aromatase inhibitor]] recommended
 '''21-day cycle for 4 cycles'''
+</div>
+<div class="toccolours" style="background-color:#cbd5e7">
 ====Subsequent treatment====
 *[[Surgery#Breast_cancer_surgery|Surgery]] was performed within 3 weeks of the end of therapy. Adjuvant therapy consisted of [[Breast_cancer#Cyclophosphamide_.26_Epirubicin_.28EC.29_2|EC]], then [[#Paclitaxel_.26_Trastuzumab_.28TH.29_2|TH (Paclitaxel)]], unless the patient had pCR in which case adjuvant therapy was optional
+</div></div>
 ===References===
 # '''WGSG ADAPT:''' Harbeck N, Gluz O, Christgen M, Kates RE, Braun M, Küemmel S, Schumacher C, Potenberg J, Kraemer S, Kleine-Tebbe A, Augustin D, Aktas B, Forstbauer H, Tio J, von Schumann R, Liedtke C, Grischke EM, Schumacher J, Wuerstlein R, Kreipe HH, Nitz UA; West German Study Group. De-escalation strategies in human epidermal growth factor receptor 2 (HER2)-positive early breast cancer (BC): Final analysis of the West German Study Group Adjuvant Dynamic marker-Adjusted Personalized Therapy trial optimizing risk assessment and therapy response prediction in early BC HER2- and hormone receptor-positive phase II randomized trial-efficacy, safety, and predictive markers for 12 weeks of neoadjuvant trastuzumab emtansine with or without endocrine therapy (ET) versus trastuzumab plus ET. J Clin Oncol. 2017 Sep 10;35(26):3046-3054. Epub 2017 Jul 6. [https://doi.org/10.1200/JCO.2016.71.9815 link to original article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/28682681 PubMed] NCT01817452
 =Adjuvant therapy=
 ==Anastrozole monotherapy {{#subobject:79h35|Regimen=1}}==
+<div class="toccolours" style="background-color:#eeeeee">
 ===Regimen {{#subobject:gav33c|Variant=1}}===
 {| class="wikitable sortable" style="width: 100%; text-align:center;"
@@ Line 134: / Line 135: @@
 |-
 |}
+<div class="toccolours" style="background-color:#cbd5e8">
 ====Preceding treatment====
 *[[Regimen_classes#Anti-HER2-based_regimen|HER2-targeted therapy]]
+</div>
+<div class="toccolours" style="background-color:#b3e2cd">
 ====Endocrine therapy====
 *[[Anastrozole (Arimidex)]] 1 mg PO once per day
 '''Continued for up to 10 years'''
+</div></div>
 ===References===
 #'''eMonarcHER:''' NCT04752332
 =Metastatic disease, first-line therapy=
 ==Anastrozole monotherapy {{#subobject:796bb|Regimen=1}}==
+<div class="toccolours" style="background-color:#eeeeee">
 ===Regimen {{#subobject:bd033c|Variant=1}}===
 {| class="wikitable sortable" style="width: 100%; text-align:center;"
@@ Line 162: / Line 164: @@
 |-
 |}
+<div class="toccolours" style="background-color:#b3e2cd">
 ====Endocrine therapy====
 *[[Anastrozole (Arimidex)]] 1 mg PO once per day
 '''28-day cycles'''
+</div></div>
 ===References===
 # '''TAnDEM:''' Kaufman B, Mackey JR, Clemens MR, Bapsy PP, Vaid A, Wardley A, Tjulandin S, Jahn M, Lehle M, Feyereislova A, Révil C, Jones A. Trastuzumab plus anastrozole versus anastrozole alone for the treatment of postmenopausal women with human epidermal growth factor receptor 2-positive, hormone receptor-positive metastatic breast cancer: results from the randomized phase III TAnDEM study. J Clin Oncol. 2009 Nov 20;27(33):5529-37. Epub 2009 Sep 28. [https://doi.org/10.1200/JCO.2008.20.6847 link to original article] '''contains dosing details in abstract''' [https://pubmed.ncbi.nlm.nih.gov/19786670 PubMed] NCT00022672
 ==Anastrozole & Trastuzumab {{#subobject:8077ad|Regimen=1}}==
+<div class="toccolours" style="background-color:#eeeeee">
 ===Regimen variant #1, weekly trastuzumab {{#subobject:e6f8f0|Variant=1}}===
 {| class="wikitable sortable" style="width: 100%; text-align:center;"
@@ Line 186: / Line 188: @@
 |-
 |}
+<div class="toccolours" style="background-color:#b3e2cd">
 ====Endocrine therapy====
 *[[Anastrozole (Arimidex)]] 1 mg PO once per day
@@ Line 192: / Line 195: @@
 **Cycle 1: 4 mg/kg IV once on day 1, then 2 mg/kg IV once per day on days 8, 15, 22
 **Cycle 2 onwards: 2 mg/kg IV once per day on days 1, 8, 15, 22
 '''28-day cycles'''
+</div></div><br>
+<div class="toccolours" style="background-color:#eeeeee">
 ===Regimen variant #2, q3wk trastuzumab {{#subobject:ugibx4|Variant=1}}===
 {| class="wikitable sortable" style="width: 100%; text-align:center;"
@@ Line 220: / Line 223: @@
 |}
 ''Note: the original ALTERNATIVE article published in 2018 was retracted due to numeric errors in the analysis, and an update has been published. Hua et al. 2022 does not contain dosing instructions for anastrozole.''
+<div class="toccolours" style="background-color:#b3e2cd">
 ====Targeted therapy====
 *[[Trastuzumab (Herceptin)]] as follows:
@@ Line 226: / Line 230: @@
 ====Endocrine therapy====
 *[[Anastrozole (Arimidex)]] 1 mg PO once per day
 '''21-day cycles'''
+</div></div>
 ===References===
 # '''TAnDEM:''' Kaufman B, Mackey JR, Clemens MR, Bapsy PP, Vaid A, Wardley A, Tjulandin S, Jahn M, Lehle M, Feyereislova A, Révil C, Jones A. Trastuzumab plus anastrozole versus anastrozole alone for the treatment of postmenopausal women with human epidermal growth factor receptor 2-positive, hormone receptor-positive metastatic breast cancer: results from the randomized phase III TAnDEM study. J Clin Oncol. 2009 Nov 20;27(33):5529-37. Epub 2009 Sep 28. [https://doi.org/10.1200/JCO.2008.20.6847 link to original article] '''contains dosing details in abstract''' [https://pubmed.ncbi.nlm.nih.gov/19786670 PubMed] NCT00022672
@@ Line 234: / Line 237: @@
 # '''ALTERNATIVE:''' Johnston SRD, Hegg R, Im SA, Park IH, Burdaeva O, Kurteva G, Press MF, Tjulandin S, Iwata H, Simon SD, Kenny S, Sarp S, Izquierdo MA, Williams LS, Gradishar WJ. Phase III, Randomized Study of Dual Human Epidermal Growth Factor Receptor 2 (HER2) Blockade With Lapatinib Plus Trastuzumab in Combination With an Aromatase Inhibitor in Postmenopausal Women With HER2-Positive, Hormone Receptor-Positive Metastatic Breast Cancer: Updated Results of ALTERNATIVE. J Clin Oncol. 2021 Jan 1;39(1):79-89. Epub 2020 Aug 21. [https://doi.org/10.1200/jco.20.01894 link to original article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/32822287 PubMed] NCT01160211
 # '''SYSUCC-002:''' Hua X, Bi XW, Zhao JL, Shi YX, Lin Y, Wu ZY, Zhang YQ, Zhang LH, Zhang AQ, Huang H, Liu XM, Xu F, Guo Y, Xia W, Hong RX, Jiang KK, Xue C, An X, Zhong YY, Wang SS, Huang JJ, Yuan ZY. Trastuzumab Plus Endocrine Therapy or Chemotherapy as First-line Treatment for Patients with Hormone Receptor-Positive and HER2-Positive Metastatic Breast Cancer (SYSUCC-002). Clin Cancer Res. 2022 Feb 15;28(4):637-645. [https://doi.org/10.1158/1078-0432.ccr-21-3435 link to original article] '''contains partial protocol''' [https://pubmed.ncbi.nlm.nih.gov/34810217/ PubMed] NCT01950182
 ==Anastrozole, Lapatinib, Trastuzumab {{#subobject:gg0dbc|Regimen=1}}==
+<div class="toccolours" style="background-color:#eeeeee">
 ===Regimen {{#subobject:ug8a84|Variant=1}}===
 {| class="wikitable sortable" style="width: 100%; text-align:center;"
@@ Line 256: / Line 258: @@
 |}
 ''Note: the original article published in 2018 was retracted due to numeric errors in the analysis, and an update has been published.''
+<div class="toccolours" style="background-color:#b3e2cd">
 ====Targeted therapy====
 *[[Lapatinib (Tykerb)]] 1000 mg PO once per day
@@ Line 263: / Line 266: @@
 ====Endocrine therapy====
 *[[Anastrozole (Arimidex)]] 1 mg PO once per day
 '''21-day cycles'''
+</div></div>
 ===References===
 <!--- # '''RETRACTED:''' Johnston SRD, Hegg R, Im SA, Park IH, Burdaeva O, Kurteva G, Press MF, Tjulandin S, Iwata H, Simon SD, Kenny S, Sarp S, Izquierdo MA, Williams LS, Gradishar WJ. Phase III, Randomized Study of Dual Human Epidermal Growth Factor Receptor 2 (HER2) Blockade With Lapatinib Plus Trastuzumab in Combination With an Aromatase Inhibitor in Postmenopausal Women With HER2-Positive, Hormone Receptor-Positive Metastatic Breast Cancer: ALTERNATIVE. J Clin Oncol. 2018 Mar 10;36(8):741-748. Epub 2017 Dec 15. [https://doi.org/10.1200/JCO.2017.74.7824 link to original article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/29244528 PubMed] -->
 # '''ALTERNATIVE:''' Johnston SRD, Hegg R, Im SA, Park IH, Burdaeva O, Kurteva G, Press MF, Tjulandin S, Iwata H, Simon SD, Kenny S, Sarp S, Izquierdo MA, Williams LS, Gradishar WJ. Phase III, Randomized Study of Dual Human Epidermal Growth Factor Receptor 2 (HER2) Blockade With Lapatinib Plus Trastuzumab in Combination With an Aromatase Inhibitor in Postmenopausal Women With HER2-Positive, Hormone Receptor-Positive Metastatic Breast Cancer: Updated Results of ALTERNATIVE. J Clin Oncol. 2021 Jan 1;39(1):79-89. Epub 2020 Aug 21. [https://doi.org/10.1200/jco.20.01894 link to original article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/32822287 PubMed] NCT01160211
 ==Exemestane & Trastuzumab {{#subobject:ugjxbc|Regimen=1}}==
+<div class="toccolours" style="background-color:#eeeeee">
 ===Regimen {{#subobject:1yga84|Variant=1}}===
 {| class="wikitable sortable" style="width: 100%; text-align:center;"
@@ Line 297: / Line 298: @@
 |}
 ''Note: the original ALTERNATIVE article published in 2018 was retracted due to numeric errors in the analysis, and an update has been published. Hua et al. 2022 does not contain dosing instructions for exemestane.''
+<div class="toccolours" style="background-color:#b3e2cd">
 ====Targeted therapy====
 *[[Trastuzumab (Herceptin)]] as follows:
@@ Line 303: / Line 305: @@
 ====Endocrine therapy====
 *[[Exemestane (Aromasin)]] 1 mg PO once per day
 '''21-day cycles'''
+</div></div>
 ===References===
 <!--- # '''RETRACTED:''' Johnston SRD, Hegg R, Im SA, Park IH, Burdaeva O, Kurteva G, Press MF, Tjulandin S, Iwata H, Simon SD, Kenny S, Sarp S, Izquierdo MA, Williams LS, Gradishar WJ. Phase III, Randomized Study of Dual Human Epidermal Growth Factor Receptor 2 (HER2) Blockade With Lapatinib Plus Trastuzumab in Combination With an Aromatase Inhibitor in Postmenopausal Women With HER2-Positive, Hormone Receptor-Positive Metastatic Breast Cancer: ALTERNATIVE. J Clin Oncol. 2018 Mar 10;36(8):741-748. Epub 2017 Dec 15. [https://doi.org/10.1200/JCO.2017.74.7824 link to original article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/29244528 PubMed] -->
 # '''ALTERNATIVE:''' Johnston SRD, Hegg R, Im SA, Park IH, Burdaeva O, Kurteva G, Press MF, Tjulandin S, Iwata H, Simon SD, Kenny S, Sarp S, Izquierdo MA, Williams LS, Gradishar WJ. Phase III, Randomized Study of Dual Human Epidermal Growth Factor Receptor 2 (HER2) Blockade With Lapatinib Plus Trastuzumab in Combination With an Aromatase Inhibitor in Postmenopausal Women With HER2-Positive, Hormone Receptor-Positive Metastatic Breast Cancer: Updated Results of ALTERNATIVE. J Clin Oncol. 2021 Jan 1;39(1):79-89. Epub 2020 Aug 21. [https://doi.org/10.1200/jco.20.01894 link to original article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/32822287 PubMed] NCT01160211
 # '''SYSUCC-002:''' Hua X, Bi XW, Zhao JL, Shi YX, Lin Y, Wu ZY, Zhang YQ, Zhang LH, Zhang AQ, Huang H, Liu XM, Xu F, Guo Y, Xia W, Hong RX, Jiang KK, Xue C, An X, Zhong YY, Wang SS, Huang JJ, Yuan ZY. Trastuzumab Plus Endocrine Therapy or Chemotherapy as First-line Treatment for Patients with Hormone Receptor-Positive and HER2-Positive Metastatic Breast Cancer (SYSUCC-002). Clin Cancer Res. 2022 Feb 15;28(4):637-645. [https://doi.org/10.1158/1078-0432.ccr-21-3435 link to original article] '''contains partial protocol''' [https://pubmed.ncbi.nlm.nih.gov/34810217/ PubMed] NCT01950182
 ==Exemestane, Lapatinib, Trastuzumab {{#subobject:hh0dbc|Regimen=1}}==
+<div class="toccolours" style="background-color:#eeeeee">
 ===Regimen {{#subobject:258gja|Variant=1}}===
 {| class="wikitable sortable" style="width: 100%; text-align:center;"
@@ Line 331: / Line 332: @@
 |}
 ''Note: the original article published in 2018 was retracted due to numeric errors in the analysis, and an update has been published.''
+<div class="toccolours" style="background-color:#b3e2cd">
 ====Targeted therapy====
 *[[Lapatinib (Tykerb)]] 1000 mg PO once per day
@@ Line 338: / Line 340: @@
 ====Endocrine therapy====
 *[[Exemestane (Aromasin)]] 25 mg PO once per day
 '''21-day cycles'''
+</div></div>
 ===References===
 <!--- # '''RETRACTED:''' Johnston SRD, Hegg R, Im SA, Park IH, Burdaeva O, Kurteva G, Press MF, Tjulandin S, Iwata H, Simon SD, Kenny S, Sarp S, Izquierdo MA, Williams LS, Gradishar WJ. Phase III, Randomized Study of Dual Human Epidermal Growth Factor Receptor 2 (HER2) Blockade With Lapatinib Plus Trastuzumab in Combination With an Aromatase Inhibitor in Postmenopausal Women With HER2-Positive, Hormone Receptor-Positive Metastatic Breast Cancer: ALTERNATIVE. J Clin Oncol. 2018 Mar 10;36(8):741-748. Epub 2017 Dec 15. [https://doi.org/10.1200/JCO.2017.74.7824 link to original article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/29244528 PubMed] -->
 # '''ALTERNATIVE:''' Johnston SRD, Hegg R, Im SA, Park IH, Burdaeva O, Kurteva G, Press MF, Tjulandin S, Iwata H, Simon SD, Kenny S, Sarp S, Izquierdo MA, Williams LS, Gradishar WJ. Phase III, Randomized Study of Dual Human Epidermal Growth Factor Receptor 2 (HER2) Blockade With Lapatinib Plus Trastuzumab in Combination With an Aromatase Inhibitor in Postmenopausal Women With HER2-Positive, Hormone Receptor-Positive Metastatic Breast Cancer: Updated Results of ALTERNATIVE. J Clin Oncol. 2021 Jan 1;39(1):79-89. Epub 2020 Aug 21. [https://doi.org/10.1200/jco.20.01894 link to original article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/32822287 PubMed] NCT01160211
 ==Lapatinib & Letrozole {{#subobject:5fba83|Regimen=1}}==
+<div class="toccolours" style="background-color:#eeeeee">
 ===Regimen {{#subobject:879969|Variant=1}}===
 {| class="wikitable sortable" style="width: 100%; text-align:center;"
@@ Line 362: / Line 362: @@
 |-
 |}
+<div class="toccolours" style="background-color:#b3e2cd">
 ====Targeted therapy====
 *[[Lapatinib (Tykerb)]] 1500 mg PO once per day
 ====Endocrine therapy====
 *[[Letrozole (Femara)]] 2.5 mg PO once per day
 '''Continued indefinitely'''
+</div></div>
 ===References===
 # '''EGF30008:''' Johnston S, Pippen J Jr, Pivot X, Lichinitser M, Sadeghi S, Dieras V, Gomez HL, Romieu G, Manikhas A, Kennedy MJ, Press MF, Maltzman J, Florance A, O'Rourke L, Oliva C, Stein S, Pegram M. Lapatinib combined with letrozole versus letrozole and placebo as first-line therapy for postmenopausal hormone receptor-positive metastatic breast cancer. J Clin Oncol. 2009 Nov 20;27(33):5538-46. Epub 2009 Sep 28. [https://doi.org/10.1200/JCO.2009.23.3734 link to original article] '''contains dosing details in abstract''' [https://pubmed.ncbi.nlm.nih.gov/19786658 PubMed] NCT00073528
 ==Lapatinib, Letrozole, Trastuzumab {{#subobject:ee0dbc|Regimen=1}}==
+<div class="toccolours" style="background-color:#eeeeee">
 ===Regimen {{#subobject:251384|Variant=1}}===
 {| class="wikitable sortable" style="width: 100%; text-align:center;"
@@ Line 393: / Line 392: @@
 |}
 ''Note: the original article published in 2018 was retracted due to numeric errors in the analysis, and an update has been published.''
+<div class="toccolours" style="background-color:#b3e2cd">
 ====Targeted therapy====
 *[[Lapatinib (Tykerb)]] 1000 mg PO once per day
@@ Line 400: / Line 400: @@
 ====Endocrine therapy====
 *[[Letrozole (Femara)]] 2.5 mg PO once per day
 '''21-day cycles'''
+</div></div>
 ===References===
 <!--- # '''RETRACTED:''' Johnston SRD, Hegg R, Im SA, Park IH, Burdaeva O, Kurteva G, Press MF, Tjulandin S, Iwata H, Simon SD, Kenny S, Sarp S, Izquierdo MA, Williams LS, Gradishar WJ. Phase III, Randomized Study of Dual Human Epidermal Growth Factor Receptor 2 (HER2) Blockade With Lapatinib Plus Trastuzumab in Combination With an Aromatase Inhibitor in Postmenopausal Women With HER2-Positive, Hormone Receptor-Positive Metastatic Breast Cancer: ALTERNATIVE. J Clin Oncol. 2018 Mar 10;36(8):741-748. Epub 2017 Dec 15. [https://doi.org/10.1200/JCO.2017.74.7824 link to original article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/29244528 PubMed] -->
 # '''ALTERNATIVE:''' Johnston SRD, Hegg R, Im SA, Park IH, Burdaeva O, Kurteva G, Press MF, Tjulandin S, Iwata H, Simon SD, Kenny S, Sarp S, Izquierdo MA, Williams LS, Gradishar WJ. Phase III, Randomized Study of Dual Human Epidermal Growth Factor Receptor 2 (HER2) Blockade With Lapatinib Plus Trastuzumab in Combination With an Aromatase Inhibitor in Postmenopausal Women With HER2-Positive, Hormone Receptor-Positive Metastatic Breast Cancer: Updated Results of ALTERNATIVE. J Clin Oncol. 2021 Jan 1;39(1):79-89. Epub 2020 Aug 21. [https://doi.org/10.1200/jco.20.01894 link to original article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/32822287 PubMed] NCT01160211
 ==Letrozole monotherapy {{#subobject:75d541|Regimen=1}}==
+<div class="toccolours" style="background-color:#eeeeee">
 ===Regimen {{#subobject:d7ef99|Variant=1}}===
 {| class="wikitable sortable" style="width: 100%; text-align:center;"
@@ Line 424: / Line 422: @@
 |-
 |}
+<div class="toccolours" style="background-color:#b3e2cd">
 ====Endocrine therapy====
 *[[Letrozole (Femara)]] 2.5 mg PO once per day
 '''28-day cycles'''
+</div></div>
 ===References===
 # '''EGF30008:''' Johnston S, Pippen J Jr, Pivot X, Lichinitser M, Sadeghi S, Dieras V, Gomez HL, Romieu G, Manikhas A, Kennedy MJ, Press MF, Maltzman J, Florance A, O'Rourke L, Oliva C, Stein S, Pegram M. Lapatinib combined with letrozole versus letrozole and placebo as first-line therapy for postmenopausal hormone receptor-positive metastatic breast cancer. J Clin Oncol. 2009 Nov 20;27(33):5538-46. Epub 2009 Sep 28. [https://doi.org/10.1200/JCO.2009.23.3734 link to original article] '''contains dosing details in abstract''' [https://pubmed.ncbi.nlm.nih.gov/19786658 PubMed] NCT00073528
 ==Letrozole & Trastuzumab {{#subobject:8ugz41|Regimen=1}}==
+<div class="toccolours" style="background-color:#eeeeee">
 ===Regimen {{#subobject:6cq284|Variant=1}}===
 {| class="wikitable sortable" style="width: 100%; text-align:center;"
@@ Line 458: / Line 456: @@
 |}
 ''Note: the original ALTERNATIVE article published in 2018 was retracted due to numeric errors in the analysis, and an update has been published. Hua et al. does not contain dosing instructions for letrozole.''
+<div class="toccolours" style="background-color:#b3e2cd">
 ====Targeted therapy====
 *[[Trastuzumab (Herceptin)]] as follows:
@@ Line 464: / Line 463: @@
 ====Endocrine therapy====
 *[[Letrozole (Femara)]] 2.5 mg PO once per day
 '''21-day cycles'''
+</div></div>
 ===References===
 <!--- # '''RETRACTED:''' Johnston SRD, Hegg R, Im SA, Park IH, Burdaeva O, Kurteva G, Press MF, Tjulandin S, Iwata H, Simon SD, Kenny S, Sarp S, Izquierdo MA, Williams LS, Gradishar WJ. Phase III, Randomized Study of Dual Human Epidermal Growth Factor Receptor 2 (HER2) Blockade With Lapatinib Plus Trastuzumab in Combination With an Aromatase Inhibitor in Postmenopausal Women With HER2-Positive, Hormone Receptor-Positive Metastatic Breast Cancer: ALTERNATIVE. J Clin Oncol. 2018 Mar 10;36(8):741-748. Epub 2017 Dec 15. [https://doi.org/10.1200/JCO.2017.74.7824 link to original article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/29244528 PubMed] -->
 # '''ALTERNATIVE:''' Johnston SRD, Hegg R, Im SA, Park IH, Burdaeva O, Kurteva G, Press MF, Tjulandin S, Iwata H, Simon SD, Kenny S, Sarp S, Izquierdo MA, Williams LS, Gradishar WJ. Phase III, Randomized Study of Dual Human Epidermal Growth Factor Receptor 2 (HER2) Blockade With Lapatinib Plus Trastuzumab in Combination With an Aromatase Inhibitor in Postmenopausal Women With HER2-Positive, Hormone Receptor-Positive Metastatic Breast Cancer: Updated Results of ALTERNATIVE. J Clin Oncol. 2021 Jan 1;39(1):79-89. Epub 2020 Aug 21. [https://doi.org/10.1200/jco.20.01894 link to original article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/32822287 PubMed] NCT01160211
 # '''SYSUCC-002:''' Hua X, Bi XW, Zhao JL, Shi YX, Lin Y, Wu ZY, Zhang YQ, Zhang LH, Zhang AQ, Huang H, Liu XM, Xu F, Guo Y, Xia W, Hong RX, Jiang KK, Xue C, An X, Zhong YY, Wang SS, Huang JJ, Yuan ZY. Trastuzumab Plus Endocrine Therapy or Chemotherapy as First-line Treatment for Patients with Hormone Receptor-Positive and HER2-Positive Metastatic Breast Cancer (SYSUCC-002). Clin Cancer Res. 2022 Feb 15;28(4):637-645. [https://doi.org/10.1158/1078-0432.ccr-21-3435 link to original article] '''contains partial protocol''' [https://pubmed.ncbi.nlm.nih.gov/34810217/ PubMed] NCT01950182
 [[Category:Breast cancer regimens]]
 [[Category:Biomarker-specific pages]]
 [[Category:Malignant breast neoplasm]]

Difference between revisions of "Breast cancer, ER and HER2 co-expressing"

Revision as of 16:57, 15 October 2022

Neoadjuvant chemotherapy

Trastuzumab emtansine monotherapy

Regimen

Antibody-drug conjugate therapy

Subsequent treatment

References

T-DM1 & ET

Regimen

Antibody-drug conjugate therapy

Endocrine therapy

Subsequent treatment

References

Trastuzumab & ET

Regimen

Targeted therapy

Endocrine therapy

Subsequent treatment

References

Adjuvant therapy

Anastrozole monotherapy

Regimen

Preceding treatment

Endocrine therapy

References

Metastatic disease, first-line therapy

Anastrozole monotherapy

Regimen

Endocrine therapy

References

Anastrozole & Trastuzumab

Regimen variant #1, weekly trastuzumab

Endocrine therapy

Targeted therapy

Regimen variant #2, q3wk trastuzumab

Targeted therapy

Endocrine therapy

References

Anastrozole, Lapatinib, Trastuzumab

Regimen

Targeted therapy

Endocrine therapy

References

Exemestane & Trastuzumab

Regimen

Targeted therapy

Endocrine therapy

References

Exemestane, Lapatinib, Trastuzumab

Regimen

Targeted therapy

Endocrine therapy

References

Lapatinib & Letrozole

Regimen

Targeted therapy

Endocrine therapy

References

Lapatinib, Letrozole, Trastuzumab

Regimen

Targeted therapy

Endocrine therapy

References

Letrozole monotherapy

Regimen

Endocrine therapy

References

Letrozole & Trastuzumab

Regimen

Targeted therapy

Endocrine therapy

References

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