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Optimizing treatment-sequencing strategies for the management of postmenopausal women with hormone receptor-positive, HER2-negative advanced breast cancer: A Malaysian perspective

Ahmad Radzi ()
Fabian Wei Luen Lee ()


The incidence of postmenopausal, hormone receptor (HR)-positive, human epidermal growth factor receptor 2-negative (HER2−) advanced breast cancer is high in Malaysia. Despite the high incidence and other challenges in the local settings, there is an unmet need for optimal treatment strategies for the management of these patients. The current article includes a comprehensive review of the key clinical evidences on the management of postmenopausal women with HR+, HER2– or unknown HER2 status advanced breast cancer, with focus on the emerging role of fulvestrant and novel combinations of hormone and targeted therapies, in improving the survival outcomes. All the evidences have been rated based on the GRADE criteria by local Oncology experts through a consensus opinion, and treatment-sequencing strategies have been proposed for the optimal first- and second-line management of this patient population. The proposed strategies may serve as a useful guide to the clinicians for optimizing the treatment of these patients. Optimization of treatment in the local context may be further improved, by addressing the immediate challenges, related to availability/ access to emerging treatments, enhancement of disease awareness and early diagnosis. Detection of driver mutations, and reliable biomarkers for predicting treatment outcomes may serve as a step ahead in the management of these patients in future.


postmenopausal advanced breast cancer; HR-positive; HER2-negative; treatment-sequencing strategies

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Faslodex receives EU approval as first-line therapy for advanced breast cancer. Available from:

Fulvestrant prescribing information. Revised Aug 2017. Available from:



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