Breast Cancer

Early (Stage I/IIA/IIB)

Surgery

HR-

HER2-

Chemotherapy

Chemotherapy options

Anthracycline based

Doxorubicin + Cyclophosphamide Q14/21 days x4 cycles (AC)

paclitaxel weekly x12 weeks

Taxane based

Docetaxel + Cyclophosphamide Q21 days x4 cycles (TC)

HER2+

Chemotherapy + Anti-HER2 therapy

HR+

HER2+

Chemotherapy + anti-HER2 therapy + Endocrine therapy

Endocrine options

SERM

Tamoxifen(PREmenopausal)

AI (POSTmenopausal)

Anastrozole
Letrozole
Exemestane

Ovarian ablation/suppression

Oophorectomy
LH releasing agents

Goserelin
leuprolide
triptorelin

CD4K inhibitors

Ribociclib
Abemaciclib
palbociclib

Chemo + anti-HER2 options

Doxorubicin + Cyclophosphamide Q14/21 days x4 cycles (AC)

paclitaxel + trastuzumab +/- pertuzumab x 1 year (pertuzumab if node positive)

Docetaxel + carboplatin + trastuzumab +/- pertuzumab Q21 days x6 cycles (TCH+/-P)

trastuzumab +/- pertuzumab x1 year

HER2-

Endocrine therapy +/- Chemotherapy

TNBC

Dose dense AC

taxane

Pembrolizumab + paclitaxel + carboplatin

pembrolizumab + AC

pembrolizumab as maintenance

Recurrent/metastatic

Chemotherapy + targeted therapy

SERM if premenopausal
AI if postmenopausal

Chemo + anti-HER2 options

Doxorubicin + Cyclophosphamide Q14/21 days x4 cycles

paclitaxel + trastuzumab +/- pertuzumab x 1 year

Docetaxel + carboplatin + trastuzumab +/- pertuzumab Q21 days x6 cycles (TCH or TCHP)

trastuzumab +/- pertuzumab x1 year