Breast Cancer

Regimen Options

Last Updated: 07/18/2025 See Details

NOTE: FOR TRASTUZUMAB, THE USE OF A BIOSIMILAR OR THE REFERENCE PRODUCT IS ON PATHWAY. PERTUZUMAB, TRASTUZUMAB, AND HYALURONIDASE-ZZXF (PHESGO) IS PATHWAY AND INTERCHANGEABLE WITH IV PERTUZUMAB + TRASTUZUMAB. LEUPROLIDE (LUPRON OR ELIGARD), TRIPTORELIN (TRELSTAR) ARE ON PATHWAY WHEN USED IN COMBINATION WITH AN AROMATASE INHIBITOR OR TAMOXIFEN.

	Evolent Pathways	Febrile Neutropenic Risk	Emetogenic Risk	References
HER2 LOW (HER2 IHC 1+ or 2+/ISH negative), ER/PR POSITIVE
Advanced/Metastatic: Initial Therapy	System chemotherapy: doxorubicin, paclitaxel, carboplatin + paclitaxel, docetaxel, cyclophosphamide, capecitabine, gemcitabine, vinorelbine, eribulin (Ok for Her2 ultralow IHC 0+)	Not Applicable	Not applicable	NCCN Guidelines® for Breast Cancer V.3.2025.
Advanced/Metastatic: Subsequent Therapy	fam-trastuzumab deruxtecan-nxki (Enhertu)	Low	Moderate	NCCN Guidelines® for Breast Cancer V.3.2025. Modi S, et al. N Engl J Med 2022; 387:9-20 Bardia, A et al. N Engl J Med 2024;391:2110-2122
	sacituzumab govitecan if not a candidate for fam-trastuzumab deruxtecan-nxki	Intermediate	High	NCCN Guidelines® for Breast Cancer V.3.2025. Bardia, A et al. N Engl J Med 2019;380:741-751
	System chemotherapy: doxorubicin, paclitaxel, carboplatin + paclitaxel, docetaxel, cyclophosphamide, capecitabine, gemcitabine, vinorelbine, eribulin (Ok for Her2 ultralow IHC 0+)	Not Applicable	Not applicable	NCCN Guidelines® for Breast Cancer V.3.2025.
HER2 POSITIVE, ER/PR POSITIVE (TRIPLE POSITIVE)
Neoadjuvant	TCH (paclitaxel, carboplatin, and trastuzumab)	Intermediate	Moderate	NCCN Guidelines® for Breast Cancer V.1.2017. Slamon D, et al. N Engl J Med. 2011;365(14):1273-83.
	TCH (docetaxel, carboplatin, and trastuzumab)	High	Moderate	NCCN Guidelines® for Breast Cancer V.1.2017. Slamon D, et al. N Engl J Med. 2011;365(14):1273-83.
	TCH (paclitaxel, carboplatin, and trastuzumab) and pertuzumab Stage II or higher	Intermediate	Moderate	NCCN Guidelines® for Breast Cancer V.1.2017. Schneeweiss A, et al. Ann Oncol. 2013;24(9):2278-84.
	TCH (docetaxel, carboplatin, and trastuzumab) and pertuzumab Stage II or higher	High	Moderate	NCCN Guidelines® for Breast Cancer V.1.2017. Schneeweiss A, et al. Ann Oncol. 2013;24(9):2278-84.
	AC (doxorubicin and cyclophosphamide) followed by paclitaxel and trastuzumab	Intermediate	High	NCCN Guidelines® for Breast Cancer V.1.2017. Romond EH, et al. N Engl J Med 2005; 353:1673-1684
Adjuvant	TCH (docetaxel, carboplatin, and trastuzumab)	High	Moderate	NCCN Guidelines® for Breast Cancer V.1.2017. Slamon D, et al. N Engl J Med. 2011;365(14):1273-83
	TCH (paclitaxel, carboplatin, and trastuzumab)	Intermediate	Moderate	NCCN Guidelines® for Breast Cancer V.1.2017. Slamon D, et al. N Engl J Med. 2011;365(14):1273-83
	TCH (paclitaxel, carboplatin, and trastuzumab) with pertuzumab	Intermediate	Moderate	NCCN Guidelines® for Breast Cancer V.1.2017. Slamon D, et al. N Engl J Med. 2011;365(14):1273-83.
	TCH (docetaxel, carboplatin, and trastuzumab) with pertuzumab	High	Moderate	NCCN Guidelines® for Breast Cancer V.1.2017. Slamon D, et al. N Engl J Med. 2011;365(14):1273-83.
	AC (doxorubicin and cyclophosphamide) followed by paclitaxel and trastuzumab	Intermediate	High	NCCN Guidelines® for Breast Cancer V.1.2017. Romond EH, et al. N Engl J Med 2005; 353:1673-1684
	paclitaxel and trastuzumab Stage 1, primary tumor size 0.6 to 2cm	Low	Low	NCCN Guidelines® for Breast Cancer V.1.2017. Tolaney SM, et al. N Engl J Med. 2015;372(2):134.
	trastuzumab up to 1 year following chemotherapy with trastuzumab	Low	Low	NCCN Drugs & Biologics Compendium® Breast Cancer V.3.2017. Romond EH, et al. N Engl J Med. 2005;Oct 20;353(16):1673-84. Slamon D, et al. N Engl J Med. 2011 Oct 6;365(14):1273-83. Joensuu H, et al. N Engl J Med. 2006 Feb 23;354(8):809-20. Dang C, et al. J Clin Oncol. 2008 Mar 10;26(8):1216-22. Gianni L, et al. Lancet Oncol. 2012 Jan;13(1):25-32. Datko FM, et al. J Clin Oncol. 2012 Sept;134: 134-134. Tolaney SM, et al. N Engl J Med. 2015 Jan 8;372(2):134-41. Schneeweiss A, et al. Ann Oncol. 2013 Sep;24(9):2278-84. Jones SF, et al. Lancet Oncol. 2013 Oct;14(11):1121-8.
	ado-trastuzumab (Kadcyla) for those with residual disease in the breast and/or axillary lymph nodes after receiving neo-adjuvant chemotherapy	Low	Low	NCCN Guidelines® for Breast Cancer V.1.2017. Minckwitz GV, et al. N Engl J Med 2019; 380:617-628
	trastuzumab and pertuzumab up to 1 year following chemotherapy with trastuzumab and pertuzumab	Low	Low	NCCN Guidelines® for Breast Cancer V.1.2017. Schneeweiss A, et al. Ann Oncol. 2013;24(9):2278-84. Minckwitz GV et al. N Engl J Med. 2017;377(2):122.
Advanced/Metastatic: Initial Therapy	THP (paclitaxel, trastuzumab, and pertuzumab)	Intermediate	Low	NCCN Guidelines® for Breast Cancer V.1.2017. Datko F, et al. Cancer Res. 2012;72(24 Suppl):abstr P5-18-20.
	THP (docetaxel, trastuzumab, and pertuzumab)	High	Low	NCCN Guidelines® for Breast Cancer V.1.2017. Baselga J, et al. N Engl J Med. 2012;366(2):109-19.
	trastuzumab and pertuzumab continuation after paclitaxel or docetaxel with trastuzumab and pertuzumab	Low	Low	NCCN Guidelines® for Breast Cancer V.1.2017. Datko F, et al. Cancer Res. 2012;72(24 Suppl):abstr P5-18-20.
	anastrozole and trastuzumab	Low	Low	NCCN Guidelines® for Breast Cancer V.1.2017. Kaufman B, et al. J Clin Oncol. 2009 Nov 20;27(33):5529-3.
	letrozole and trastuzumab	Low	Low	NCCN Guidelines® for Breast Cancer V.1.2017. Kaufman B, et al. J Clin Oncol. 2009 Nov 20;27(33):5529-3.
	exemestane and trastuzumab	Low	Low	NCCN Guidelines® for Breast Cancer V.1.2017. Kaufman B, et al. J Clin Oncol. 2009 Nov 20;27(33):5529-3.
	lapatinib and letrozole	Low	Low	NCCN Guidelines® for Breast Cancer V.1.2017. Johnston S, et al. J Clin Oncol. 2009 Nov 20;27(33):5538-46.
Advanced/Metastatic: Subsequent Therapy	ado-trastuzumab (Kadcyla)	Low	Low	NCCN Guidelines® for Breast Cancer V.1.2017. Verma S, et al. N Engl J Med. 2012;367(19):1783-91.
	fam-trastuzumab deruxtecan-nxki (Enhertu)	Low	Moderate	NCCN Guidelines® for Breast Cancer V.1.2017. Cortés J et al. N Engl J Med 2022; 386:1143-1154
	paclitaxel, trastuzumab, and pertuzumab if regimen not used previously	Intermediate	Low	NCCN Guidelines® for Breast Cancer V.1.2017. Datko F, et al. Cancer Res. 2012;72(24 Suppl):abstr P5-18-20.
	docetaxel, trastuzumab, and pertuzumab if regimen not used previously	High	Low	NCCN Guidelines® for Breast Cancer V.1.2017. Datko F, et al. Cancer Res. 2012;72(24 Suppl):abstr P5-18-20.
	trastuzumab and pertuzumab continuation after paclitaxel or docetaxel, with trastuzumab and pertuzumab	Low	Low	NCCN Guidelines® for Breast Cancer V.1.2017. Datko F, et al. Cancer Res. 2012;72(24 Suppl):abstr P5-18-20.
	capecitabine and trastuzumab	Low	Low	NCCN Guidelines® for Breast Cancer V.1.2017. von Minckwitz G, et al. J Clin Oncol. 2009;27(12):1999-2006. Bartsch R, et al. J Clin Oncol. 2007;25(25):3853-8.
	docetaxel and trastuzumab	High	Low	NCCN Guidelines® for Breast Cancer V.1.2017. Marty M, et al. J Clin Oncol. 2005;23(19):4265-74.
	gemcitabine and trastuzumab	Low	Low	NCCN Guidelines® for Breast Cancer V.3.2017. Yardley DA, et al. Clin Breast Cancer. 2009;9(3):178-83. Di Lauro V, et al. J Oncol. 2012;2012:198412.
	paclitaxel and trastuzumab	Intermediate	Low	NCCN Guidelines® for Breast Cancer V.1.2017. Slamon DJ, et al. N Engl J Med. 2001;344(11):783-92. Leyland-Jones B, et al. J Clin Oncol. 2003;21(21):3965-71.
	vinorelbine and trastuzumab	Low	Low	NCCN Guidelines® for Breast Cancer V.1.2017. Burstein HJ, et al. Cancer. 2007;110(5):965-72. Andersson M, et al. J Clin Oncol. 2011;29(3):264.71.
	anastrozole	Low	Low	NCCN Drugs & Biologics Compendium® Breast Cancer V.3.2017. ARIMIDEX® (anastrozole) tablets, package insert. Wilmington, DE: AstraZeneca Pharmaceuticals LP; 2009 Apr. FDA Label.
	letrozole	Low	Low	NCCN Drugs & Biologics Compendium® Breast Cancer V.3.2017. FEMARA® (letrozole) tablets, package insert. East Hanover, NJ: Novartis Pharmaceuticals Corporation; Initial U.S. Approval:1997. FDA Label.
	exemestane	Low	Low	NCCN Drugs & Biologics Compendium® Breast Cancer V.3.2017. AROMASIN® (exemestane) tablets, package insert. New York, NY: Pfizer Pharmaceuticals Inc; 2016, Jul. FDA Label.
	anastrozole and trastuzumab	Low	Low	NCCN Guidelines® for Breast Cancer V.1.2017. Kaufman B, et al. J Clin Oncol. 2009 Nov 20;27(33):5529-3.
	letrozole and trastuzumab	Low	Low	NCCN Guidelines® for Breast Cancer V.1.2017. Kaufman B, et al. J Clin Oncol. 2009 Nov 20;27(33):5529-3.
	exemestane and trastuzumab	Low	Low	NCCN Guidelines® for Breast Cancer V.1.2017. Kaufman B, et al. J Clin Oncol. 2009 Nov 20;27(33):5529-3.
	lapatinib and letrozole	Low	Low	NCCN Guidelines® for Breast Cancer V.1.2017. Johnston S, et al. J Clin Oncol. 2009 Nov 20;27(33):5538-46.
	tucatinib, trastuzumab, and capecitabine 3rd line and beyond	Low	Low	NCCN Guidelines® for Breast Cancer V.1.2017. Murthy RK et al. N Engl J Med . 2020 Feb 13;382(7):597-609.
	Best Supportive Care or Clinical Trial	Not Applicable	Not applicable	NCCN Guidelines® for Supportive Care.
HER2 POSITIVE, ER/PR NEGATIVE
Neoadjuvant	TCH (paclitaxel, carboplatin, and trastuzumab)	Intermediate	Moderate	NCCN Guidelines® for Breast Cancer V.1.2017. Slamon D, et al. N Engl J Med. 2011;365(14):1273-83.
	TCH (docetaxel, carboplatin, and trastuzumab)	High	Moderate	NCCN Guidelines® for Breast Cancer V.1.2017. Slamon D, et al. N Engl J Med. 2011;365(14):1273-83.
	TCH (docetaxel, carboplatin, and trastuzumab) with pertuzumab Stage II or higher	High	Moderate	NCCN Guidelines® for Breast Cancer V.1.2017. Slamon D, et al. N Engl J Med. 2011;365(14):1273-83.
	TCH (paclitaxel, carboplatin, and trastuzumab) with pertuzumab Stage II or higher	Intermediate	Moderate	NCCN Guidelines® for Breast Cancer V.1.2017. Slamon D, et al. N Engl J Med. 2011;365(14):1273-83.
	AC (doxorubicin and cyclophosphamide) followed by paclitaxel and trastuzumab	Intermediate	High	NCCN Guidelines® for Breast Cancer V.1.2017. Romond EH, et al. N Engl J Med 2005; 353:1673-1684
Adjuvant	TCH (docetaxel, carboplatin, and trastuzumab)	High	Moderate	NCCN Guidelines® for Breast Cancer V.1.2017. Slamon D, et al. N Engl J Med. 2011;365(14):1273-83
	TCH (docetaxel, carboplatin, and trastuzumab)	High	Moderate	NCCN Guidelines® for Breast Cancer V.1.2017. Slamon D, et al. N Engl J Med. 2011;365(14):1273-83.
	TCH (docetaxel, carboplatin, and trastuzumab) with pertuzumab Stage II or higher	High	Moderate	NCCN Guidelines® for Breast Cancer V.1.2017. Slamon D, et al. N Engl J Med. 2011;365(14):1273-83.
	TCH (paclitaxel, carboplatin, and trastuzumab) with pertuzumab Stage II or higher	Intermediate	Moderate	NCCN Guidelines® for Breast Cancer V.1.2017. Slamon D, et al. N Engl J Med. 2011;365(14):1273-83.
	AC (doxorubicin and cyclophosphamide) followed by paclitaxel and trastuzumab	Intermediate	High	NCCN Guidelines® for Breast Cancer V.1.2017. Romond EH, et al. N Engl J Med 2005; 353:1673-1684
Adjuvant	TCH (docetaxel, carboplatin, and trastuzumab)	High	Moderate	NCCN Guidelines® for Breast Cancer V.1.2017. Slamon D, et al. N Engl J Med. 2011;365(14):1273-83
	TCH (paclitaxel, carboplatin, and trastuzumab)	Intermediate	Moderate	NCCN Guidelines® for Breast Cancer V.1.2017. Slamon D, et al. N Engl J Med. 2011;365(14):1273-83
	TCH (paclitaxel, carboplatin, and trastuzumab) with pertuzumab	Intermediate	Moderate	NCCN Guidelines® for Breast Cancer V.1.2017. Slamon D, et al. N Engl J Med. 2011;365(14):1273-83.
	AC (doxorubicin and cyclophosphamide) followed by paclitaxel and trastuzumab	Intermediate	High	NCCN Guidelines® for Breast Cancer V.1.2017. Romond EH, et al. N Engl J Med 2005; 353:1673-1684
	paclitaxel and trastuzumab Stage 1, primary tumor size 0.6 to 2cm	Low	Low	NCCN Guidelines® for Breast Cancer V.1.2017. Tolaney SM, et al. N Engl J Med. 2015;372(2):134.
	trastuzumab up to 1 year following chemotherapy with trastuzumab	Low	Low	NCCN Drugs & Biologics Compendium® Breast Cancer V.3.2017. Romond EH, et al. N Engl J Med. 2005;Oct 20;353(16):1673-84. Slamon D, et al. N Engl J Med. 2011 Oct 6;365(14):1273-83. Joensuu H, et al. N Engl J Med. 2006 Feb 23;354(8):809-20. Dang C, et al. J Clin Oncol. 2008 Mar 10;26(8):1216-22. Gianni L, et al. Lancet Oncol. 2012 Jan;13(1):25-32. Datko FM, et al. J Clin Oncol. 2012 Sept;134: 134-134. Tolaney SM, et al. N Engl J Med. 2015 Jan 8;372(2):134-41. Schneeweiss A, et al. Ann Oncol. 2013 Sep;24(9):2278-84. Jones SF, et al. Lancet Oncol. 2013 Oct;14(11):1121-8.
	ado-trastuzumab (Kadcyla) for those with residual disease in the breast and/or axillary lymph nodes after receiving neo-adjuvant chemotherapy	Low	Low	NCCN Guidelines® for Breast Cancer V.1.2017. Minckwitz GV, et al. N Engl J Med 2019; 380:617-628
	trastuzumab and pertuzumab up to 1 year following chemotherapy with trastuzumab and pertuzumab	Low	Low	NCCN Guidelines® for Breast Cancer V.1.2017. Schneeweiss A, et al. Ann Oncol. 2013;24(9):2278-84. Minckwitz GV et al. N Engl J Med. 2017;377(2):122.
Advanced/Metastatic: Initial Therapy	THP (paclitaxel, trastuzumab, and pertuzumab)	Intermediate	Low	NCCN Guidelines® for Breast Cancer V.1.2017. Datko F, et al. Cancer Res. 2012;72(24 Suppl):abstr P5-18-20.
	THP (docetaxel, trastuzumab, and pertuzumab)	High	Low	NCCN Guidelines® for Breast Cancer V.1.2017. Baselga J, et al. N Engl J Med. 2012;366(2):109-19.
	trastuzumab and pertuzumab continuation after paclitaxel/docetaxel, trastuzumab and pertuzumab	Low	Low	NCCN Guidelines® for Breast Cancer V.1.2017. Datko F, et al. Cancer Res. 2012;72(24 Suppl):abstr P5-18-20.
Advanced/Metastatic: Subsequent Therapy	ado-trastuzumab (Kadcyla)	Low	Low	NCCN Guidelines® for Breast Cancer V.1.2017. Verma S, et al. N Engl J Med. 2012;367(19):1783-91.
	fam-trastuzumab deruxtecan-nxki (Enhertu)	Low	Moderate	NCCN Guidelines® for Breast Cancer V.1.2017. Cortés J et al. N Engl J Med 2022; 386:1143-1154
	docetaxel with trastuzumab and pertuzumab if regimen not used previously	Intermediate	Low	NCCN Guidelines® for Breast Cancer V.1.2017. Datko F, et al. Cancer Res. 2012;72(24 Suppl):abstr P5-18-20.
	paclitaxel with trastuzumab and pertuzumab if regimen not used previously	Intermediate	Low	NCCN Guidelines® for Breast Cancer V.1.2017. Datko F, et al. Cancer Res. 2012;72(24 Suppl):abstr P5-18-20.
	trastuzumab with pertuzumab (continuation after paclitaxel/docetaxel with trastuzumab and pertuzumab)	Low	Low	NCCN Guidelines® for Breast Cancer V.1.2017. Datko F, et al. Cancer Res. 2012;72(24 Suppl):abstr P5-18-20.
	lapatinib and capecitabine	Low	Low	NCCN Guidelines® for Breast Cancer V.1.2017. Geyer CE, et al. N Engl J Med. 2006 Dec 28;355(26):2733-43.
	capecitabine and trastuzumab	Low	Low	NCCN Guidelines® for Breast Cancer V.1.2017. von Minckwitz G, et al. J Clin Oncol. 2009;27(12):1999-2006. Bartsch R, et al. J Clin Oncol. 2007;25(25):3853-8.
	docetaxel and trastuzumab	Intermediate	Low	NCCN Guidelines® for Breast Cancer V.1.2017. Marty M, et al. J Clin Oncol. 2005;23(19):4265-74.
	gemcitabine and trastuzumab	Low	Low	NCCN Guidelines® for Breast Cancer V.3.2017. Yardley DA, et al. Clin Breast Cancer. 2009;9(3):178-83. Di Lauro V, et al. J Oncol. 2012;2012:198412.
	paclitaxel and trastuzumab	Intermediate	Low	NCCN Guidelines® for Breast Cancer V.1.2017. Slamon DJ, et al. N Engl J Med. 2001;344(11):783-92. Leyland-Jones B, et al. J Clin Oncol. 2003;21(21):3965-71.
	vinorelbine and trastuzumab	Low	Low	NCCN Guidelines® for Breast Cancer V.1.2017. Burstein HJ, et al. Cancer. 2007;110(5):965-72. Andersson M, et al. J Clin Oncol. 2011;29(3):264.71.
	tucatinib, trastuzumab, and capecitabine 3rd line and beyond	Low	Low	NCCN Guidelines® for Breast Cancer V.1.2017. Murthy RK et al. N Engl J Med . 2020 Feb 13;382(7):597-609.
	Best Supportive Care or Clinical Trial	Not Applicable	Not applicable	NCCN Guidelines® for Supportive Care clinicaltrial.gov
HER2 NEGATIVE, ER/PR POSITIVE
Neoadjuvant	Dose Dense AC (doxorubicin and cyclophosphamide)	High	High	NCCN Guidelines® for Breast Cancer V.1.2017. Fisher B, et al. J Clin Oncol. 1990;8(9):1483-96. Nabholtz JM, et al. J Clin Oncol. 2003;21(6):968-75.
	AC (doxorubicin and cyclophosphamide) followed by paclitaxel	High	High	NCCN Guidelines® for Breast Cancer V.1.2017. Sparano JA, et al. N Engl J Med. 2008;358(16):1663-71.
	Dose Dense AC (doxorubicin and cyclophosphamide) followed by paclitaxel	High	High	NCCN Guidelines® for Breast Cancer V.1.2017. Sparano JA, et al. N Engl J Med. 2008;358(16):1663-71.
	TC (docetaxel and cyclophosphamide)	Intermediate	High	NCCN Guidelines® for Breast Cancer V.1.2017. Jones SE, et al. J Clin Oncol. 2009;27(8):1177-83.
	tamoxifen	Low	Minimal	NCCN Drugs & Biologics Compendium® Breast Cancer V.3.2017. NOLVADEX® (Tamoxifen Citrate) tablets, package insert. Wilmington, DE: AstraZeneca Pharmaceuticals LP; 2002 Aug, FDA Label.
	anastrozole	Low	Low	NCCN Drugs & Biologics Compendium® Breast Cancer V.3.2017. ARIMIDEX® (anastrozole) tablets, package insert. Wilmington, DE: AstraZeneca Pharmaceuticals LP; 2009 Apr. FDA Label.
	letrozole	Low	Low	NCCN Drugs & Biologics Compendium® Breast Cancer V.3.2017. FEMARA® (letrozole) tablets, package insert. East Hanover, NJ: Novartis Pharmaceuticals Corporation; Initial U.S. Approval:1997. FDA Label.
	exemestane	Low	Low	NCCN Drugs & Biologics Compendium® Breast Cancer V.3.2017. AROMASIN® (exemestane) tablets, package insert. New York, NY: Pfizer Pharmaceuticals Inc; 2016, Jul. FDA Label.
	anastrozole and leuprolide	Low	Low	NCCN Drugs & Biologics Compendium® Breast Cancer V.3.2017. NOLVADEX® (Tamoxifen Citrate) tablets, package insert. Wilmington, DE: AstraZeneca Pharmaceuticals LP; 2002 Aug, FDA Label. LUPRON DEPOT® (leuprolide acetate) depot suspension, package insert. North Chicago, IL: Takeda Pharmaceutical Company Limited; 2013, Oct. FDA Label.
	letrozole and leuprolide	Low	Low	NCCN Drugs & Biologics Compendium® Breast Cancer V.3.2017. NOLVADEX® (Tamoxifen Citrate) tablets, package insert. Wilmington, DE: AstraZeneca Pharmaceuticals LP; 2002 Aug, FDA Label. LUPRON DEPOT® (leuprolide acetate) depot suspension, package insert. North Chicago, IL: Takeda Pharmaceutical Company Limited; 2013, Oct. FDA Label.
	exemestane and leuprolide	Low	Low	NCCN Drugs & Biologics Compendium® Breast Cancer V.3.2017. NOLVADEX® (Tamoxifen Citrate) tablets, package insert. Wilmington, DE: AstraZeneca Pharmaceuticals LP; 2002 Aug, FDA Label. LUPRON DEPOT® (leuprolide acetate) depot suspension, package insert. North Chicago, IL: Takeda Pharmaceutical Company Limited; 2013, Oct. FDA Label.
	tamoxifen and leuprolide	Low	Low	NCCN Drugs & Biologics Compendium® Breast Cancer V.3.2017. NOLVADEX® (Tamoxifen Citrate) tablets, package insert. Wilmington, DE: AstraZeneca Pharmaceuticals LP; 2002 Aug, FDA Label. LUPRON DEPOT® (leuprolide acetate) depot suspension, package insert. North Chicago, IL: Takeda Pharmaceutical Company Limited; 2013, Oct. FDA Label.
Adjuvant	Dose Dense AC (doxorubicin and cyclophosphamide)	High	High	NCCN Guidelines® for Breast Cancer V.1.2017. Fisher B, et al. J Clin Oncol. 1990;8(9):1483-96. Nabholtz JM, et al. J Clin Oncol. 2003;21(6):968-75.
	AC (doxorubicin and cyclophosphamide) followed by paclitaxel*	High	High	NCCN Guidelines® for Breast Cancer V.1.2017. Sparano JA, et al. N Engl J Med. 2008;358(16):1663-71.
	Dose Dense AC (doxorubicin and cyclophosphamide) followed by paclitaxel*	High	High	NCCN Guidelines® for Breast Cancer V.1.2017. Sparano JA, et al. N Engl J Med. 2008;358(16):1663-71.
	TC (docetaxel and cyclophosphamide)	Intermediate	High	NCCN Guidelines® for Breast Cancer V.1.2017. Jones SE, et al. J Clin Oncol. 2009;27(8):1177-83.
	abemaciclib and endocrine therapy (eg tamoxifen/aromatase inhibitor ± leuprolide (high risk of recurrence)	Low	Low	NCCN Guidelines® for Breast Cancer V.1.2017. Johnston S, et al. https://pubmed.ncbi.nlm.nih.gov/32954927/. Harbeck N et al. DOI:https://doi.org/10.1016/j.annonc.2021.09.015
	tamoxifen	Low	Minimal	NCCN Drugs & Biologics Compendium® Breast Cancer V.3.2017. NOLVADEX® (Tamoxifen Citrate) tablets, package insert. Wilmington, DE: AstraZeneca Pharmaceuticals LP; 2002 Aug, FDA Label.
	anastrozole	Low	Low	NCCN Drugs & Biologics Compendium® Breast Cancer V.3.2017. ARIMIDEX® (anastrozole) tablets, package insert. Wilmington, DE: AstraZeneca Pharmaceuticals LP; 2009 Apr. FDA Label.
	letrozole	Low	Low	NCCN Drugs & Biologics Compendium® Breast Cancer V.3.2017. FEMARA® (letrozole) tablets, package insert. East Hanover, NJ: Novartis Pharmaceuticals Corporation; Initial U.S. Approval:1997. FDA Label.
	exemestane	Low	Low	NCCN Drugs & Biologics Compendium® Breast Cancer V.3.2017. AROMASIN® (exemestane) tablets, package insert. New York, NY: Pfizer Pharmaceuticals Inc; 2016, Jul. FDA Label.
	anastrozole and leuprolide	Low	Low	NCCN Drugs & Biologics Compendium® Breast Cancer V.3.2017. NOLVADEX® (Tamoxifen Citrate) tablets, package insert. Wilmington, DE: AstraZeneca Pharmaceuticals LP; 2002 Aug, FDA Label. LUPRON DEPOT® (leuprolide acetate) depot suspension, package insert. North Chicago, IL: Takeda Pharmaceutical Company Limited; 2013, Oct. FDA Label.
	letrozole and leuprolide	Low	Low	NCCN Drugs & Biologics Compendium® Breast Cancer V.3.2017. NOLVADEX® (Tamoxifen Citrate) tablets, package insert. Wilmington, DE: AstraZeneca Pharmaceuticals LP; 2002 Aug, FDA Label. LUPRON DEPOT® (leuprolide acetate) depot suspension, package insert. North Chicago, IL: Takeda Pharmaceutical Company Limited; 2013, Oct. FDA Label.
	exemestane and leuprolide	Low	Low	NCCN Drugs & Biologics Compendium® Breast Cancer V.3.2017. NOLVADEX® (Tamoxifen Citrate) tablets, package insert. Wilmington, DE: AstraZeneca Pharmaceuticals LP; 2002 Aug, FDA Label. LUPRON DEPOT® (leuprolide acetate) depot suspension, package insert. North Chicago, IL: Takeda Pharmaceutical Company Limited; 2013, Oct. FDA Label.
	tamoxifen and leuprolide	Low	Low	NCCN Drugs & Biologics Compendium® Breast Cancer V.3.2017. NOLVADEX® (Tamoxifen Citrate) tablets, package insert. Wilmington, DE: AstraZeneca Pharmaceuticals LP; 2002 Aug, FDA Label. LUPRON DEPOT® (leuprolide acetate) depot suspension, package insert. North Chicago, IL: Takeda Pharmaceutical Company Limited; 2013, Oct. FDA Label.
	olaparib (BRCAm)	Low	Moderate	NCCN Drugs & Biologics Compendium® Breast Cancer V.3.2017. Tutt A et al. N Engl J Med 2021; 384:2394-2405 . Geyer CE Jr. Ann Oncol . 2022 Dec;33(12):1250-1268.
Advanced/Metastatic: Initial Therapy	ribociclib and anastrozole	Low	Low	NCCN Guidelines® for Breast Cancer V.3.2017. Hortobagyi GN, et al. N Engl J Med. 2016;375(18):1738-1748. Curigliano G, et al. Breast. 2016;28:191-8.
	ribociclib and letrozole	Low	Low	NCCN Guidelines® for Breast Cancer V.3.2017. Hortobagyi GN, et al. N Engl J Med. 2016;375(18):1738-1748. Curigliano G, et al. Breast. 2016;28:191-8.
	ribociclib and exemestane	Low	Low	NCCN Guidelines® for Breast Cancer V.3.2017. Hortobagyi GN, et al. N Engl J Med. 2016;375(18):1738-1748. Curigliano G, et al. Breast. 2016;28:191-8.
	palbociclib and anastrozole	Low	Low	NCCN Guidelines® for Breast Cancer V.5.2024. Rugo HS, et al. npj Breast Cancer 8, 114 (2022). Kappel C, et al. Sci Rep 14, 3129 (2024).
	palbociclib and letrozole	Low	Low	NCCN Guidelines® for Breast Cancer V.5.2024. Rugo HS, et al. npj Breast Cancer 8, 114 (2022). Kappel C, et al. Sci Rep 14, 3129 (2024).
	palbociclib and exemestane	Low	Low	NCCN Guidelines® for Breast Cancer V.5.2024. Rugo HS, et al. npj Breast Cancer 8, 114 (2022). Kappel C, et al. Sci Rep 14, 3129 (2024).
	abemaciclib and anastrozole	Low	Low	NCCN Guidelines® for Breast Cancer V.3.2017. Goetz MP, et al. J Clin Oncol . 2017 Nov 10;35(32):3638-3646.
	abemaciclib and letrozole	Low	Low	NCCN Guidelines® for Breast Cancer V.3.2017. Goetz MP, et al. J Clin Oncol . 2017 Nov 10;35(32):3638-3646.
	abemaciclib and exemestane	Low	Low	NCCN Guidelines® for Breast Cancer V.3.2017. Goetz MP, et al. J Clin Oncol . 2017 Nov 10;35(32):3638-3646.
	ribociclib and fulvestrant	Low	Low	NCCN Guidelines® for Breast Cancer V.3.2017. Slamon DJ et al. J Clin Oncol. 2018 Aug 20;36(24):2465-2472.
	palbociclib and fulvestrant	Low	Low	NCCN Guidelines® for Breast Cancer V.5.2024. Turner NC et al. N Engl J Med 2018;379:1926-1936.
	abemaciclib and fulvestrant	Low	Low	NCCN Guidelines® for Breast Cancer V.3.2017. Sledge GW et al. JAMA Oncol. 2020 Jan; 6(1): 116–124.
	fulvestrant	Low	Low	NCCN Drugs & Biologics Compendium® Breast Cancer V.3.2017. FASLODEX® (fulvestrant) injection, package insert. Wilmington, DE: AstraZeneca Pharmaceuticals LP; Initial U.S. Approval:2002. FDA Label.
	capivasertib and fulvestrant (PIK3CA/AKT1/PTEN-alterations)	Low	Low	NCCN Drugs & Biologics Compendium® Breast Cancer V.5.2024. Turner NC et al. N Engl J Med 2023;388:2058-2070.
	alpelisib and fulvestrant (PIK3CA-mutated)	Low	Minimal	NCCN Drugs & Biologics Compendium® Breast Cancer V.5.2024. André, F et al. https://doi.org/10.1016/j.annonc.2020.11.011.
	anastrozole and leuprolide	Low	Low	NCCN Drugs & Biologics Compendium® Breast Cancer V.3.2017. NOLVADEX® (Tamoxifen Citrate) tablets, package insert. Wilmington, DE: AstraZeneca Pharmaceuticals LP; 2002 Aug, FDA Label. LUPRON DEPOT® (leuprolide acetate) depot suspension, package insert. North Chicago, IL: Takeda Pharmaceutical Company Limited; 2013, Oct. FDA Label.
	letrozole and leuprolide	Low	Low	NCCN Drugs & Biologics Compendium® Breast Cancer V.3.2017. NOLVADEX® (Tamoxifen Citrate) tablets, package insert. Wilmington, DE: AstraZeneca Pharmaceuticals LP; 2002 Aug, FDA Label. LUPRON DEPOT® (leuprolide acetate) depot suspension, package insert. North Chicago, IL: Takeda Pharmaceutical Company Limited; 2013, Oct. FDA Label.
	exemestane and leuprolide	Low	Low	NCCN Drugs & Biologics Compendium® Breast Cancer V.3.2017. NOLVADEX® (Tamoxifen Citrate) tablets, package insert. Wilmington, DE: AstraZeneca Pharmaceuticals LP; 2002 Aug, FDA Label. LUPRON DEPOT® (leuprolide acetate) depot suspension, package insert. North Chicago, IL: Takeda Pharmaceutical Company Limited; 2013, Oct. FDA Label.
	tamoxifen and leuprolide	Low	Minimal	NCCN Drugs & Biologics Compendium® Breast Cancer V.3.2017. NOLVADEX® (Tamoxifen Citrate) tablets, package insert. Wilmington, DE: AstraZeneca Pharmaceuticals LP; 2002 Aug, FDA Label. LUPRON DEPOT® (leuprolide acetate) depot suspension, package insert. North Chicago, IL: Takeda Pharmaceutical Company Limited; 2013, Oct. FDA Label.
	doxorubicin	Low	High	NCCN Guidelines® for Breast Cancer V.1.2017. Chan S, et al. J Clin Oncol. 1999 Aug;17(8):2341-54.
	capecitabine	Low	Low	NCCN Guidelines® for Breast Cancer V.1.2017. Bajetta E, et al. J Clin Oncol. 2005;23(10):2155-61.
	paclitaxel	Intermediate	Low	NCCN Guidelines® for Breast Cancer V.3.2017. Seidman AD, et al. J Clin Oncol. 1995;13(10):2575-81. Perez EA, et al. J Clin Oncol. 2001;19(22):4216-23.
	docetaxel	Intermediate	Low	NCCN Guidelines® for Breast Cancer V.1.2017. Burris HA, Semin Oncol. 1999;26(3 suppl 9):1-6. Harvey V, et al. J Clin Oncol. 2006;24(31):4963-70. Rivera E, et al. Cancer. 2008;112(7):1455-61.
	gemcitabine	Low	Low	NCCN Guidelines® for Breast Cancer V.1.2017. Seidman AD. Oncology (Williston Park). 2001;15(2 suppl 3):11-4.
	anastrozole	Low	Low	NCCN Drugs & Biologics Compendium® Breast Cancer V.3.2017. ARIMIDEX® (anastrozole) tablets, package insert. Wilmington, DE: AstraZeneca Pharmaceuticals LP; 2009 Apr. FDA Label.
	letrozole	Low	Low	NCCN Drugs & Biologics Compendium® Breast Cancer V.3.2017. FEMARA® (letrozole) tablets, package insert. East Hanover, NJ: Novartis Pharmaceuticals Corporation; Initial U.S. Approval:1997. FDA Label.
	exemestane	Low	Low	NCCN Drugs & Biologics Compendium® Breast Cancer V.3.2017. AROMASIN® (exemestane) tablets, package insert. New York, NY: Pfizer Pharmaceuticals Inc; 2016, Jul. FDA Label.
	tamoxifen	Low	Minimal	NCCN Drugs & Biologics Compendium® Breast Cancer V.3.2017. AROMASIN® (exemestane) tablets, package insert. New York, NY: Pfizer Pharmaceuticals Inc; 2016, Jul. FDA Label.
Advanced/Metastatic: Subsequent Therapy	capecitabine	Low	Low	NCCN Guidelines® for Breast Cancer V.1.2017. Bajetta E, et al. J Clin Oncol. 2005;23(10):2155-61.
	gemcitabine	Low	Low	NCCN Guidelines® for Breast Cancer V.1.2017. Seidman AD. Oncology (Williston Park). 2001;15(2 suppl 3):11-4.
	paclitaxel	Intermediate	Low	NCCN Guidelines® for Breast Cancer V.3.2017. Seidman AD, et al. J Clin Oncol. 1995;13(10):2575-81. Perez EA, et al. J Clin Oncol. 2001;19(22):4216-23.
	docetaxel	Intermediate	Low	NCCN Guidelines® for Breast Cancer V.1.2017. Burris HA, Semin Oncol. 1999;26(3 suppl 9):1-6. Harvey V, et al. J Clin Oncol. 2006;24(31):4963-70. Rivera E, et al. Cancer. 2008;112(7):1455-61.
	vinorelbine	Low	Low	NCCN Guidelines® for Breast Cancer V.3.2017. Zelek L, et al. Cancer. 2001;92(9):2267-72.
	capivasertib and fulvestrant (PIK3CA/AKT1/PTEN-alterations)	Low	Low	NCCN Drugs & Biologics Compendium® Breast Cancer V.5.2024. Turner NC et al. N Engl J Med 2023;388:2058-2070.
	alpelisib and fulvestrant (PIK3CA-mutated)	Low	Minimal	NCCN Drugs & Biologics Compendium® Breast Cancer V.5.2024. André, F et al. https://doi.org/10.1016/j.annonc.2020.11.011.
	anastrozole	Low	Low	NCCN Drugs & Biologics Compendium® Breast Cancer V.3.2017. ARIMIDEX® (anastrozole) tablets, package insert. Wilmington, DE: AstraZeneca Pharmaceuticals LP; 2009 Apr. FDA Label.
	letrozole	Low	Low	NCCN Drugs & Biologics Compendium® Breast Cancer V.3.2017. FEMARA® (letrozole) tablets, package insert. East Hanover, NJ: Novartis Pharmaceuticals Corporation; Initial U.S. Approval:1997. FDA Label.
	exemestane	Low	Low	NCCN Drugs & Biologics Compendium® Breast Cancer V.3.2017. AROMASIN® (exemestane) tablets, package insert. New York, NY: Pfizer Pharmaceuticals Inc; 2016, Jul. FDA Label.
	tamoxifen and leuprolide	Low	Minimal	NCCN Drugs & Biologics Compendium® Breast Cancer V.3.2017. NOLVADEX® (Tamoxifen Citrate) tablets, package insert. Wilmington, DE: AstraZeneca Pharmaceuticals LP; 2002 Aug, FDA Label. LUPRON DEPOT® (leuprolide acetate) depot suspension, package insert. North Chicago, IL: Takeda Pharmaceutical Company Limited; 2013, Oct. FDA Label.
	anastrozole and leuprolide	Low	Low	NCCN Drugs & Biologics Compendium® Breast Cancer V.3.2017. NOLVADEX® (Tamoxifen Citrate) tablets, package insert. Wilmington, DE: AstraZeneca Pharmaceuticals LP; 2002 Aug, FDA Label. LUPRON DEPOT® (leuprolide acetate) depot suspension, package insert. North Chicago, IL: Takeda Pharmaceutical Company Limited; 2013, Oct. FDA Label.
	letrozole and leuprolide	Low	Low	NCCN Drugs & Biologics Compendium® Breast Cancer V.3.2017. NOLVADEX® (Tamoxifen Citrate) tablets, package insert. Wilmington, DE: AstraZeneca Pharmaceuticals LP; 2002 Aug, FDA Label. LUPRON DEPOT® (leuprolide acetate) depot suspension, package insert. North Chicago, IL: Takeda Pharmaceutical Company Limited; 2013, Oct. FDA Label.
	exemestane and leuprolide	Low	Low	NCCN Drugs & Biologics Compendium® Breast Cancer V.3.2017. NOLVADEX® (Tamoxifen Citrate) tablets, package insert. Wilmington, DE: AstraZeneca Pharmaceuticals LP; 2002 Aug, FDA Label. LUPRON DEPOT® (leuprolide acetate) depot suspension, package insert. North Chicago, IL: Takeda Pharmaceutical Company Limited; 2013, Oct. FDA Label.
	fulvestrant	Low	Low	NCCN Drugs & Biologics Compendium® Breast Cancer V.3.2017. FASLODEX® (fulvestrant) injection, package insert. Wilmington, DE: AstraZeneca Pharmaceuticals LP; Initial U.S. Approval:2002. FDA Label.
	exemestane and everolimus failed prior hormone treatment; post menopause	Low	Low	NCCN Guidelines® for Breast Cancer V.3.2017. Baselga J, et al. N Engl J Med. 2012;366(6):520-9.
	ribociclib and fulvestrant	Low	Low	NCCN Guidelines® for Breast Cancer V.3.2017. Slamon DJ et al. J Clin Oncol. 2018 Aug 20;36(24):2465-2472.
	palbociclib and fulvestrant	Low	Low	NCCN Guidelines® for Breast Cancer V.3.2017. Cristofanilli M et al. DOI:https://doi.org/10.1016/S1470-2045(15)00613-0
	abemaciclib and fulvestrant	Low	Low	NCCN Drugs & Biologics Compendium® Breast Cancer V.3.2017. VERZENIO™ (abemaciclib) tablets, package insert. Indianapolis, IN:Lilly USA, LLC; Initial U.S. Approval:2017. FDA Label.
	abemaciclib failed prior hormone and chemotherapy regimens in metastatic setting	Low	Low	NCCN Drugs & Biologics Compendium® Breast Cancer V.3.2017. VERZENIO™ (abemaciclib) tablets, package insert. Indianapolis, IN:Lilly USA, LLC; Initial U.S. Approval:2017. FDA Label.
	olaparib BRCA germline mutation	Low	Moderate	NCCN Drugs & Biologics Compendium® Breast Cancer V.3.2017. LYNPARZA® (olaparib) tablet, package insert. Wilmington, DE: AstraZeneca Pharmaceuticals LP; Initial U.S. Approval:2014. FDA Label.
	sacituzumab govitecan	Low	High	NCCN Drugs & Biologics Compendium® Breast Cancer V.2.2024. Rugo et al. Lancet 2023; 402: 1423–33
	Best Supportive Care or Clinical Trial	Not Applicable	Not applicable	NCCN Guidelines® for Supportive Care.
HER2 NEGATIVE, ER/PR NEGATIVE (TRIPLE NEGATIVE)
NeoAdjuvant/Adjuvant	Dose Dense AC (doxorubicin and cyclophosphamide) followed by paclitaxel every 2 weeks	High	High	NCCN Guidelines® for Breast Cancer V.3.2017. Fisher B, et al. J Clin Oncol. 1990;8(9):1483-96. Nabholtz JM, et al. J Clin Oncol. 2003;21(6):968-75. Citron ML, et al. J Clin Oncol. 2003 Apr 15;21(8):1431-9.
	Dose Dense AC (doxorubicin and cyclophosphamide) followed by weekly paclitaxel	High	High	NCCN Guidelines® for Breast Cancer V.3.2017. Sparano JA, et al. N Engl J Med. 2008;358(16):1663-71.
	TC (docetaxel and cyclophosphamide)	Intermediate	High	NCCN Guidelines® for Breast Cancer V.3.2017. Jones SE, et al. J Clin Oncol. 2009;27(8):1177-83.
	pembrolizumab and chemotherapy* followed by pembrolizumab after surgery (total 1year); *carboplatin and paclitaxel (cycles 1-4) then doxorubicin or epirubicin and cyclophosphamide (cycles 5-8) and pembrolizumab q3weeks (cycles 1-8) followed by single agent pembrolizumab q3weeks (cycles 1-9) after surgery	Intermediate	High	NCCN Guidelines® for Breast Cancer V.3.2017. Schmid P et al. N Engl J Med 2020; 382:810-821
Adjuvant	olaparib (BRCAm)	Low	Moderate	NCCN Drugs & Biologics Compendium® Breast Cancer V.3.2017. Tutt A et al. N Engl J Med 2021; 384:2394-2405 . Geyer CE Jr. Ann Oncol . 2022 Dec;33(12):1250-1268.
	capecitabine	Low	Low	NCCN Drugs & Biologics Compendium® Breast Cancer V.3.2017. Masuda N et al. N Engl J Med 2017; 376:2147-2159
Advanced/Metastatic: Initial Therapy	gemcitabine	Low	High	NCCN Guidelines® for Breast Cancer V.3.2017. Seidman AD. Oncology (Williston Park). 2001;15(2 suppl 3):11-4.
	gemcitabine and carboplatin	Low	High	NCCN Guidelines® for Breast Cancer V.3.2017. O’Shaughnessy J, et al. N Engl J Med. 2011;364(3):205-14.
	cisplatin	Low	High	NCCN Guidelines® for Breast Cancer V.3.2017. Silver DP, et al. J Clin Oncol. 2010;28(7):1145-53.
	carboplatin	Low	Moderate	NCCN Guidelines® for Breast Cancer V.3.2017. Isakoff SJ, et al. J Clin Oncol. 2015;33(17):1902-9.
	paclitaxel	Intermediate	Low	NCCN Guidelines® for Breast Cancer V.3.2017. Seidman AD, et al. J Clin Oncol. 1995;13(10):2575-81. Perez EA, et al. J Clin Oncol. 2001;19(22):4216-23.
	docetaxel	Intermediate	Low	NCCN Guidelines® for Breast Cancer V.1.2017. Burris HA, Semin Oncol. 1999;26(3 suppl 9):1-6. Harvey V, et al. J Clin Oncol. 2006;24(31):4963-70. Rivera E, et al. Cancer. 2008;112(7):1455-61.
	pembrolizumab and paclitaxel with CPS ≥10	Low	Low	NCCN Guidelines® for Breast Cancer V.1.2017. Cortes J et al. DOI:https://doi.org/10.1016/S0140-6736(20)32531-9
	pembrolizumab, carboplatin, and gemcitabine with CPS ≥10	Low	Moderate	NCCN Guidelines® for Breast Cancer V.1.2017. Cortes J et al. DOI:https://doi.org/10.1016/S0140-6736(20)32531-9
Advanced/Metastatic: Subsequent Therapy	carboplatin	Low	Moderate	NCCN Guidelines® for Breast Cancer V.3.2017. Isakoff SJ, et al. J Clin Oncol. 2015;33(17):1902-9.
	cisplatin	Low	High	NCCN Guidelines® for Breast Cancer V.3.2017. Silver DP, et al. J Clin Oncol. 2010;28(7):1145-53.
	capecitabine	Low	Low	NCCN Guidelines® for Breast Cancer V.1.2017. Bajetta E, et al. J Clin Oncol. 2005;23(10):2155-61.
	gemcitabine	Low	Low	NCCN Guidelines® for Breast Cancer V.3.2017. Seidman AD. Oncology (Williston Park). 2001;15(2 suppl 3):11-4.
	paclitaxel	Intermediate	Low	NCCN Guidelines® for Breast Cancer V.3.2017. Seidman AD, et al. J Clin Oncol. 1995;13(10):2575-81. Perez EA, et al. J Clin Oncol. 2001;19(22):4216-23.
	docetaxel	Intermediate	Low	NCCN Guidelines® for Breast Cancer V.1.2017. Burris HA, Semin Oncol. 1999;26(3 suppl 9):1-6. Harvey V, et al. J Clin Oncol. 2006;24(31):4963-70. Rivera E, et al. Cancer. 2008;112(7):1455-61.
	vinorelbine	Low	Low	NCCN Guidelines® for Breast Cancer V.3.2017. Zelek L, et al. Cancer. 2001;92(9):2267-72.
	eribulin	Low	Low	NCCN Guidelines® for Breast Cancer V.3.2017. Cortes J, et al. Lancet. 2011;377(9769):914-23.
	olaparib BRCA germline mutation	Low	Moderate	NCCN Drugs & Biologics Compendium® Breast Cancer V.3.2017. LYNPARZA® (olaparib) tablet, package insert. Wilmington, DE: AstraZeneca Pharmaceuticals LP; Initial U.S. Approval:2014. FDA Label.
	sacituzumab govitecan	Low	High	NCCN Drugs & Biologics Compendium® Breast Cancer V.3.2017. Bardia A et al. Sacituzumab Govitecan in Metastatic Triple-Negative Breast Cancer. N Engl J Med 2021; 384:1529-1541
	Best Supportive Care or Clinical Trial	Not Applicable	Not applicable	NCCN Guidelines® for Supportive Care.

HER2 LOW (HER2 IHC 1+ or 2+/ISH negative), ER/PR POSITIVE

Advanced/Metastatic: Initial Therapy

Evolent Pathways

System chemotherapy: doxorubicin, paclitaxel, carboplatin + paclitaxel, docetaxel, cyclophosphamide, capecitabine, gemcitabine, vinorelbine, eribulin (Ok for Her2 ultralow IHC 0+)

Febrile Neutropenic Risk

Emetogenic Risk

References

Advanced/Metastatic: Subsequent Therapy

Evolent Pathways

fam-trastuzumab deruxtecan-nxki (Enhertu)

Febrile Neutropenic Risk

low

Emetogenic Risk

moderate

References

Evolent Pathways

sacituzumab govitecan *if not a candidate for fam-trastuzumab deruxtecan-nxki*

Febrile Neutropenic Risk

intermediate

Emetogenic Risk

high

References

Evolent Pathways

System chemotherapy: doxorubicin, paclitaxel, carboplatin + paclitaxel, docetaxel, cyclophosphamide, capecitabine, gemcitabine, vinorelbine, eribulin (Ok for Her2 ultralow IHC 0+)

Febrile Neutropenic Risk

Emetogenic Risk

References

HER2 POSITIVE, ER/PR POSITIVE (TRIPLE POSITIVE)

Neoadjuvant

Evolent Pathways

TCH (paclitaxel, carboplatin, and trastuzumab)

Febrile Neutropenic Risk

intermediate

Emetogenic Risk

moderate

References

Evolent Pathways

TCH (docetaxel, carboplatin, and trastuzumab)

Febrile Neutropenic Risk

high

Emetogenic Risk

moderate

References

Evolent Pathways

TCH (paclitaxel, carboplatin, and trastuzumab) and pertuzumab *Stage II or higher*

Febrile Neutropenic Risk

intermediate

Emetogenic Risk

moderate

References

Evolent Pathways

TCH (docetaxel, carboplatin, and trastuzumab) and pertuzumab *Stage II or higher*

Febrile Neutropenic Risk

high

Emetogenic Risk

moderate

References

Evolent Pathways

AC (doxorubicin and cyclophosphamide) followed by paclitaxel and trastuzumab

Febrile Neutropenic Risk

intermediate

Emetogenic Risk

high

References

Adjuvant

Evolent Pathways

TCH (docetaxel, carboplatin, and trastuzumab)

Febrile Neutropenic Risk

high

Emetogenic Risk

moderate

References

Evolent Pathways

TCH (paclitaxel, carboplatin, and trastuzumab)

Febrile Neutropenic Risk

intermediate

Emetogenic Risk

moderate

References

Evolent Pathways

TCH (paclitaxel, carboplatin, and trastuzumab) with pertuzumab

Febrile Neutropenic Risk

intermediate

Emetogenic Risk

moderate

References

Evolent Pathways

TCH (docetaxel, carboplatin, and trastuzumab) with pertuzumab

Febrile Neutropenic Risk

high

Emetogenic Risk

moderate

References

Evolent Pathways

AC (doxorubicin and cyclophosphamide) followed by paclitaxel and trastuzumab

Febrile Neutropenic Risk

intermediate

Emetogenic Risk

high

References

Evolent Pathways

paclitaxel and trastuzumab *Stage 1, primary tumor size 0.6 to 2cm*

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

trastuzumab *up to 1 year following chemotherapy with trastuzumab*

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

ado-trastuzumab (Kadcyla) *for those with residual disease in the breast and/or axillary lymph nodes after receiving neo-adjuvant chemotherapy*

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

trastuzumab and pertuzumab *up to 1 year following chemotherapy with trastuzumab and pertuzumab*

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Advanced/Metastatic: Initial Therapy

Evolent Pathways

THP (paclitaxel, trastuzumab, and pertuzumab)

Febrile Neutropenic Risk

intermediate

Emetogenic Risk

low

References

Evolent Pathways

THP (docetaxel, trastuzumab, and pertuzumab)

Febrile Neutropenic Risk

high

Emetogenic Risk

low

References

Evolent Pathways

trastuzumab and pertuzumab *continuation after paclitaxel or docetaxel with trastuzumab and pertuzumab*

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

anastrozole and trastuzumab

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

letrozole and trastuzumab

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

exemestane and trastuzumab

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

lapatinib and letrozole

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Advanced/Metastatic: Subsequent Therapy

Evolent Pathways

ado-trastuzumab (Kadcyla)

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

fam-trastuzumab deruxtecan-nxki (Enhertu)

Febrile Neutropenic Risk

low

Emetogenic Risk

moderate

References

Evolent Pathways

paclitaxel, trastuzumab, and pertuzumab *if regimen not used previously*

Febrile Neutropenic Risk

intermediate

Emetogenic Risk

low

References

Evolent Pathways

docetaxel, trastuzumab, and pertuzumab *if regimen not used previously*

Febrile Neutropenic Risk

high

Emetogenic Risk

low

References

Evolent Pathways

trastuzumab and pertuzumab *continuation after paclitaxel or docetaxel, with trastuzumab and pertuzumab*

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

capecitabine and trastuzumab

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

docetaxel and trastuzumab

Febrile Neutropenic Risk

high

Emetogenic Risk

low

References

Evolent Pathways

gemcitabine and trastuzumab

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

paclitaxel and trastuzumab

Febrile Neutropenic Risk

intermediate

Emetogenic Risk

low

References

Evolent Pathways

vinorelbine and trastuzumab

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

anastrozole

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

letrozole

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

exemestane

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

anastrozole and trastuzumab

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

letrozole and trastuzumab

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

exemestane and trastuzumab

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

lapatinib and letrozole

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

tucatinib, trastuzumab, and capecitabine *3rd line and beyond*

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

Best Supportive Care or Clinical Trial

Febrile Neutropenic Risk

Emetogenic Risk

References

HER2 POSITIVE, ER/PR NEGATIVE

Neoadjuvant

Evolent Pathways

TCH (paclitaxel, carboplatin, and trastuzumab)

Febrile Neutropenic Risk

intermediate

Emetogenic Risk

moderate

References

Evolent Pathways

TCH (docetaxel, carboplatin, and trastuzumab)

Febrile Neutropenic Risk

high

Emetogenic Risk

moderate

References

Evolent Pathways

TCH (docetaxel, carboplatin, and trastuzumab) with pertuzumab *Stage II or higher*

Febrile Neutropenic Risk

high

Emetogenic Risk

moderate

References

Evolent Pathways

TCH (paclitaxel, carboplatin, and trastuzumab) with pertuzumab *Stage II or higher*

Febrile Neutropenic Risk

intermediate

Emetogenic Risk

moderate

References

Evolent Pathways

AC (doxorubicin and cyclophosphamide) followed by paclitaxel and trastuzumab

Febrile Neutropenic Risk

intermediate

Emetogenic Risk

high

References

Adjuvant

Evolent Pathways

TCH (docetaxel, carboplatin, and trastuzumab)

Febrile Neutropenic Risk

high

Emetogenic Risk

moderate

References

Evolent Pathways

TCH (docetaxel, carboplatin, and trastuzumab)

Febrile Neutropenic Risk

high

Emetogenic Risk

moderate

References

Evolent Pathways

TCH (docetaxel, carboplatin, and trastuzumab) with pertuzumab *Stage II or higher*

Febrile Neutropenic Risk

high

Emetogenic Risk

moderate

References

Evolent Pathways

TCH (paclitaxel, carboplatin, and trastuzumab) with pertuzumab *Stage II or higher*

Febrile Neutropenic Risk

intermediate

Emetogenic Risk

moderate

References

Evolent Pathways

AC (doxorubicin and cyclophosphamide) followed by paclitaxel and trastuzumab

Febrile Neutropenic Risk

intermediate

Emetogenic Risk

high

References

Adjuvant

Evolent Pathways

TCH (docetaxel, carboplatin, and trastuzumab)

Febrile Neutropenic Risk

high

Emetogenic Risk

moderate

References

Evolent Pathways

TCH (paclitaxel, carboplatin, and trastuzumab)

Febrile Neutropenic Risk

intermediate

Emetogenic Risk

moderate

References

Evolent Pathways

TCH (paclitaxel, carboplatin, and trastuzumab) with pertuzumab

Febrile Neutropenic Risk

intermediate

Emetogenic Risk

moderate

References

Evolent Pathways

AC (doxorubicin and cyclophosphamide) followed by paclitaxel and trastuzumab

Febrile Neutropenic Risk

intermediate

Emetogenic Risk

high

References

Evolent Pathways

paclitaxel and trastuzumab *Stage 1, primary tumor size 0.6 to 2cm*

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

trastuzumab *up to 1 year following chemotherapy with trastuzumab*

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

ado-trastuzumab (Kadcyla) *for those with residual disease in the breast and/or axillary lymph nodes after receiving neo-adjuvant chemotherapy*

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

trastuzumab and pertuzumab *up to 1 year following chemotherapy with trastuzumab and pertuzumab*

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Advanced/Metastatic: Initial Therapy

Evolent Pathways

THP (paclitaxel, trastuzumab, and pertuzumab)

Febrile Neutropenic Risk

intermediate

Emetogenic Risk

low

References

Evolent Pathways

THP (docetaxel, trastuzumab, and pertuzumab)

Febrile Neutropenic Risk

high

Emetogenic Risk

low

References

Evolent Pathways

trastuzumab and pertuzumab *continuation after paclitaxel/docetaxel, trastuzumab and pertuzumab*

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Advanced/Metastatic: Subsequent Therapy

Evolent Pathways

ado-trastuzumab (Kadcyla)

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

fam-trastuzumab deruxtecan-nxki (Enhertu)

Febrile Neutropenic Risk

low

Emetogenic Risk

moderate

References

Evolent Pathways

docetaxel with trastuzumab and pertuzumab *if regimen not used previously*

Febrile Neutropenic Risk

intermediate

Emetogenic Risk

low

References

Evolent Pathways

paclitaxel with trastuzumab and pertuzumab *if regimen not used previously*

Febrile Neutropenic Risk

intermediate

Emetogenic Risk

low

References

Evolent Pathways

trastuzumab with pertuzumab (continuation after paclitaxel/docetaxel with trastuzumab and pertuzumab)

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

lapatinib and capecitabine

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

capecitabine and trastuzumab

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

docetaxel and trastuzumab

Febrile Neutropenic Risk

intermediate

Emetogenic Risk

low

References

Evolent Pathways

gemcitabine and trastuzumab

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

paclitaxel and trastuzumab

Febrile Neutropenic Risk

intermediate

Emetogenic Risk

low

References

Evolent Pathways

vinorelbine and trastuzumab

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

tucatinib, trastuzumab, and capecitabine *3rd line and beyond*

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

Best Supportive Care or Clinical Trial

Febrile Neutropenic Risk

Emetogenic Risk

References

HER2 NEGATIVE, ER/PR POSITIVE

Neoadjuvant

Evolent Pathways

Dose Dense AC (doxorubicin and cyclophosphamide)

Febrile Neutropenic Risk

high

Emetogenic Risk

high

References

Evolent Pathways

AC (doxorubicin and cyclophosphamide) followed by paclitaxel

Febrile Neutropenic Risk

high

Emetogenic Risk

high

References

Evolent Pathways

Dose Dense AC (doxorubicin and cyclophosphamide) followed by paclitaxel

Febrile Neutropenic Risk

high

Emetogenic Risk

high

References

Evolent Pathways

TC (docetaxel and cyclophosphamide)

Febrile Neutropenic Risk

intermediate

Emetogenic Risk

high

References

Evolent Pathways

tamoxifen

Febrile Neutropenic Risk

low

Emetogenic Risk

minimal

References

Evolent Pathways

anastrozole

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

letrozole

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

exemestane

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

anastrozole and leuprolide

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

letrozole and leuprolide

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

exemestane and leuprolide

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

tamoxifen and leuprolide

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Adjuvant

Evolent Pathways

Dose Dense AC (doxorubicin and cyclophosphamide)

Febrile Neutropenic Risk

high

Emetogenic Risk

high

References

Evolent Pathways

AC (doxorubicin and cyclophosphamide) followed by paclitaxel*

Febrile Neutropenic Risk

high

Emetogenic Risk

high

References

Evolent Pathways

Dose Dense AC (doxorubicin and cyclophosphamide) followed by paclitaxel*

Febrile Neutropenic Risk

high

Emetogenic Risk

high

References

Evolent Pathways

TC (docetaxel and cyclophosphamide)

Febrile Neutropenic Risk

intermediate

Emetogenic Risk

high

References

Evolent Pathways

abemaciclib and endocrine therapy (eg tamoxifen/aromatase inhibitor ± leuprolide (high risk of recurrence)

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

tamoxifen

Febrile Neutropenic Risk

low

Emetogenic Risk

minimal

References

Evolent Pathways

anastrozole

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

letrozole

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

exemestane

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

anastrozole and leuprolide

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

letrozole and leuprolide

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

exemestane and leuprolide

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

tamoxifen and leuprolide

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

olaparib (BRCAm)

Febrile Neutropenic Risk

low

Emetogenic Risk

moderate

References

Advanced/Metastatic: Initial Therapy

Evolent Pathways

ribociclib and anastrozole

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

ribociclib and letrozole

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

ribociclib and exemestane

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

palbociclib and anastrozole

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

palbociclib and letrozole

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

palbociclib and exemestane

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

abemaciclib and anastrozole

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

abemaciclib and letrozole

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

abemaciclib and exemestane

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

ribociclib and fulvestrant

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

palbociclib and fulvestrant

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

abemaciclib and fulvestrant

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

fulvestrant

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

capivasertib and fulvestrant (PIK3CA/AKT1/PTEN-alterations)

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

alpelisib and fulvestrant (PIK3CA-mutated)

Febrile Neutropenic Risk

low

Emetogenic Risk

minimal

References

Evolent Pathways

anastrozole and leuprolide

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

letrozole and leuprolide

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

exemestane and leuprolide

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

tamoxifen and leuprolide

Febrile Neutropenic Risk

low

Emetogenic Risk

minimal

References

Evolent Pathways

doxorubicin

Febrile Neutropenic Risk

low

Emetogenic Risk

high

References

Evolent Pathways

capecitabine

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

paclitaxel

Febrile Neutropenic Risk

intermediate

Emetogenic Risk

low

References

Evolent Pathways

docetaxel

Febrile Neutropenic Risk

intermediate

Emetogenic Risk

low

References

Evolent Pathways

gemcitabine

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

anastrozole

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

letrozole

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

exemestane

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

tamoxifen

Febrile Neutropenic Risk

low

Emetogenic Risk

minimal

References

Advanced/Metastatic: Subsequent Therapy

Evolent Pathways

capecitabine

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

gemcitabine

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

paclitaxel

Febrile Neutropenic Risk

intermediate

Emetogenic Risk

low

References

Evolent Pathways

docetaxel

Febrile Neutropenic Risk

intermediate

Emetogenic Risk

low

References

Evolent Pathways

vinorelbine

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

capivasertib and fulvestrant (PIK3CA/AKT1/PTEN-alterations)

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

alpelisib and fulvestrant (PIK3CA-mutated)

Febrile Neutropenic Risk

low

Emetogenic Risk

minimal

References

Evolent Pathways

anastrozole

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

letrozole

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

exemestane

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

tamoxifen and leuprolide

Febrile Neutropenic Risk

low

Emetogenic Risk

minimal

References

Evolent Pathways

anastrozole and leuprolide

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

letrozole and leuprolide

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

exemestane and leuprolide

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

fulvestrant

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

exemestane and everolimus *failed prior hormone treatment; post menopause*

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

ribociclib and fulvestrant

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

palbociclib and fulvestrant

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

abemaciclib and fulvestrant

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

abemaciclib *failed prior hormone and chemotherapy regimens in metastatic setting*

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

olaparib *BRCA germline mutation*

Febrile Neutropenic Risk

low

Emetogenic Risk

moderate

References

Evolent Pathways

sacituzumab govitecan

Febrile Neutropenic Risk

low

Emetogenic Risk

high

References

Evolent Pathways

Best Supportive Care or Clinical Trial

Febrile Neutropenic Risk

Emetogenic Risk

References

HER2 NEGATIVE, ER/PR NEGATIVE (TRIPLE NEGATIVE)

NeoAdjuvant/Adjuvant

Evolent Pathways

Dose Dense AC (doxorubicin and cyclophosphamide) followed by paclitaxel every 2 weeks

Febrile Neutropenic Risk

high

Emetogenic Risk

high

References

Evolent Pathways

Dose Dense AC (doxorubicin and cyclophosphamide) followed by weekly paclitaxel

Febrile Neutropenic Risk

high

Emetogenic Risk

high

References

Evolent Pathways

TC (docetaxel and cyclophosphamide)

Febrile Neutropenic Risk

intermediate

Emetogenic Risk

high

References

Evolent Pathways

pembrolizumab and chemotherapy* followed by pembrolizumab after surgery (total 1year); *carboplatin and paclitaxel (cycles 1-4) then doxorubicin or epirubicin and cyclophosphamide (cycles 5-8) and pembrolizumab q3weeks (cycles 1-8) followed by single agent pembrolizumab q3weeks (cycles 1-9) after surgery

Febrile Neutropenic Risk

intermediate

Emetogenic Risk

high

References

Adjuvant

Evolent Pathways

olaparib (BRCAm)

Febrile Neutropenic Risk

low

Emetogenic Risk

moderate

References

Evolent Pathways

capecitabine

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Advanced/Metastatic: Initial Therapy

Evolent Pathways

gemcitabine

Febrile Neutropenic Risk

low

Emetogenic Risk

high

References

Evolent Pathways

gemcitabine and carboplatin

Febrile Neutropenic Risk

low

Emetogenic Risk

high

References

Evolent Pathways

cisplatin

Febrile Neutropenic Risk

low

Emetogenic Risk

high

References

Evolent Pathways

carboplatin

Febrile Neutropenic Risk

low

Emetogenic Risk

moderate

References

Evolent Pathways

paclitaxel

Febrile Neutropenic Risk

intermediate

Emetogenic Risk

low

References

Evolent Pathways

docetaxel

Febrile Neutropenic Risk

intermediate

Emetogenic Risk

low

References

Evolent Pathways

pembrolizumab and paclitaxel with CPS ≥10

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

pembrolizumab, carboplatin, and gemcitabine with CPS ≥10

Febrile Neutropenic Risk

low

Emetogenic Risk

moderate

References

Advanced/Metastatic: Subsequent Therapy

Evolent Pathways

carboplatin

Febrile Neutropenic Risk

low

Emetogenic Risk

moderate

References

Evolent Pathways

cisplatin

Febrile Neutropenic Risk

low

Emetogenic Risk

high

References

Evolent Pathways

capecitabine

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

gemcitabine

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

paclitaxel

Febrile Neutropenic Risk

intermediate

Emetogenic Risk

low

References

Evolent Pathways

docetaxel

Febrile Neutropenic Risk

intermediate

Emetogenic Risk

low

References

Evolent Pathways

vinorelbine

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

eribulin

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

olaparib *BRCA germline mutation*

Febrile Neutropenic Risk

low

Emetogenic Risk

moderate

References

Evolent Pathways

sacituzumab govitecan

Febrile Neutropenic Risk

low

Emetogenic Risk

high

References

Evolent Pathways

Best Supportive Care or Clinical Trial

Febrile Neutropenic Risk

Emetogenic Risk

References

	Regimen	Alternative	References
LOW VALUE REGIMENS (NON-PATHWAY) WITH SUPERIOR ALTERNATIVES
Third-line therapy and beyond in HER2-positive disease	margetuximab-cmkb and chemotherapy (capecitabine or eribulin or gemcitabine or vinorelbine)	Alternative: Trastuzumab + chemotherapy
Initial and subsequent therapy	liposomal doxorubicin (Doxil)	Alternative: doxorubicin
Second Line	datopotamab deruxtecan-dlnk	Alternative: sacituzumab govitecan, systemic chemotherapy (e.g. eribulin, vinorelbine, capecitabine, gemcitabine)	https://ascopubs.org/doi/10.1200/JCO.24.00920
Neoadjuvant/adjuvant therapy; Initial, subsequent therapy	albumin-bound paclitaxel (Abraxane)	Alternative: paclitaxel	A Review Of Nab-Paclitaxel (Abraxane)
Neoadjuvant/adjuvant therapy; Initial, subsequent therapy	carboplatin + albumin-bound paclitaxel (Abraxane)	Alternative: carboplatin + paclitaxel

LOW VALUE REGIMENS (NON-PATHWAY) WITH SUPERIOR ALTERNATIVES

Third-line therapy and beyond in HER2-positive disease

Regimen

** margetuximab-cmkb and chemotherapy (capecitabine or eribulin or gemcitabine or vinorelbine) **

Initial and subsequent therapy

Regimen

** liposomal doxorubicin (Doxil) **

Second Line

Regimen

** datopotamab deruxtecan-dlnk **

References

Neoadjuvant/adjuvant therapy; Initial, subsequent therapy

Regimen

** albumin-bound paclitaxel (Abraxane) **

References

Neoadjuvant/adjuvant therapy; Initial, subsequent therapy

Regimen

** carboplatin + albumin-bound paclitaxel (Abraxane) **

Pathways and Low-Value Regimens

Breast Cancer