← Breast Invasive Ductal Carcinoma (IDC)

Breast Invasive Ductal Carcinoma (IDC): treatment map

Standard care plus compounds studied in the literature, organized by clinical readiness.

Educational only. This is not medical advice and not a recommendation. Confirm anything here with your oncology team.

Treatment map: Breast Invasive Ductal Carcinoma (IDC)

Standard care plus every compound studied in the literature (each cited) and graded by evidence, organized by clinical readiness. A category, not a verdict that anything works — confirm anything here with your oncology team.

128

Interventions

Standard of care

Tested in people

Lab / animal

Named in lit.

Classes

Standard of care (50) Guideline option (2) Tested in people (29) Lab / animal only (2) Named in the literature (45)

Tested in people, by trial phase: phase not reported ×29

Clinical evidence

Preclinical evidence

Standard of care

Guideline option

Tested in people

Lab / animal only

Named in the literature

Surgery & procedures

—

Radiotherapy

—

Chemotherapy

—

Targeted therapy

—

Immunotherapy

—

Hormonal therapy

—

Repurposed drugs

—

Supplements & natural agents

—

Other

—

Columns group into clinical evidence (used in, or tested on, people) and preclinical evidence (lab/animal, or only named in the literature). Cell = number of interventions; a dashed cell means none recorded there.

Established care — detail (52)

Surgery & procedures

Breast-conserving surgery (lumpectomy) + SLNB when feasible Breast-conserving surgery (lumpectomy) + SLNB when feasible; oncoplastic techniques expand eligibility and cosmesis.	Curative	Standard	Curated
Mastectomy when disease extent, multicentricity, prior RT, or patient preference dictates; nipple-sparing Mastectomy when disease extent, multicentricity, prior RT, or patient preference dictates; nipple-sparing is feasible in selected cases with careful margin assessment.	Curative	Standard	Curated
Immediate reconstruction planning (implant or autologous) Immediate reconstruction planning (implant or autologous) should be coordinated with anticipated radiation to minimize complications and optimize outcomes.	Curative	Standard	Curated
Z0011 approach: omit ALND with 1–2 positive SLNs if lumpectomy + whole-breast RT Z0011 approach: omit ALND with 1–2 positive SLNs if lumpectomy + whole-breast RT is planned and no gross extranodal extension.	Curative	Standard	Curated
Targeted axillary dissection post-NAT for initially node-positive patients (retrieve clipped node + SLNs) to accurately restage and potentially de-escalate ALND Targeted axillary dissection post-NAT for initially node-positive patients (retrieve clipped node + SLNs) to accurately restage and potentially de-escalate ALND.	Curative	Standard	Curated
Re-excision for positive margins; for invasive cancer, ‘no ink on tumor’ Re-excision for positive margins; for invasive cancer, ‘no ink on tumor’ is adequate. For pure DCIS, aim ≥2 mm.	Curative	Standard	Curated
Place surgical clips in the tumor bed to guide boost RT and future imaging Place surgical clips in the tumor bed to guide boost RT and future imaging.	Curative	Standard	Curated

Radiotherapy

Whole-breast irradiation (WBI) after lumpectomy Whole-breast irradiation (WBI) after lumpectomy is standard; hypofractionation preferred for most (e.g., ~3 weeks). Five-fraction regimens are reasonable in selected patients.	—	Standard	Curated
Tumor-bed boost for higher local-recurrence risk (younger age, close margins, high grade, extensive intraductal component) Tumor-bed boost for higher local-recurrence risk (younger age, close margins, high grade, extensive intraductal component).	—	Standard	Curated
Post-mastectomy radiation (PMRT) for ≥4 positive nodes Post-mastectomy radiation (PMRT) for ≥4 positive nodes; consider for 1–3 positive nodes with additional risk factors (large tumor, LVI, close margins).	—	Standard	Curated
Regional nodal irradiation (RNI) to axillary/supraclavicular ± internal mammary nodes based on nodal burden, biology, and response to NAT Regional nodal irradiation (RNI) to axillary/supraclavicular ± internal mammary nodes based on nodal burden, biology, and response to NAT.	—	Standard	Curated
Deep-inspiration breath hold (DIBH) for left-sided WBI/PMRT to reduce heart dose Deep-inspiration breath hold (DIBH) for left-sided WBI/PMRT to reduce heart dose; consider proton therapy in select complex IMN cases.	—	Standard	Curated
Stereotactic radiosurgery (SRS) for limited brain metastases Stereotactic radiosurgery (SRS) for limited brain metastases; SBRT for oligometastatic bone/liver/lung lesions case-by-case.	Advanced / metastatic	Standard	Curated
Partial-breast irradiation (PBI) Partial-breast irradiation (PBI) can be considered for carefully selected low-risk early cases as a shorter alternative to WBI.	—	Standard	Curated
Oligometastatic disease: discuss consolidative local therapy (SBRT, surgery) after systemic response in a multidisciplinary tumor board Oligometastatic disease: discuss consolidative local therapy (SBRT, surgery) after systemic response in a multidisciplinary tumor board.	Advanced / metastatic	Standard	Curated
Oligometastatic scenarios (all subtypes): consider SBRT or surgery after systemic response in tumor board Oligometastatic scenarios (all subtypes): consider SBRT or surgery after systemic response in tumor board.	Advanced / metastatic	Standard	Curated

Chemotherapy

Ovarian protection: consider GnRH agonist during chemotherapy for premenopausal patients to reduce ovarian failure risk and preserve fertility Ovarian protection: consider GnRH agonist during chemotherapy for premenopausal patients to reduce ovarian failure risk and preserve fertility.	—	Standard	Curated
AC-T (doxorubicin/cyclophosphamide → paclitaxel) (early/high-risk) Common adjuvant/neoadjuvant backbone; monitor cardiotoxicity and neuropathy.	—	Standard	Curated
TC (docetaxel/cyclophosphamide) (early) Non-anthracycline option; consider in lower cardiac reserve.	—	Standard	Curated
THP / TCHP (taxane ± carboplatin + trastuzumab/pertuzumab) (HER2+ neoadjuvant) Preferred for stage II–III HER2+; adapt adjuvant based on pCR/residual disease.	Neoadjuvant	Standard	Curated
Capecitabine (post-neoadjuvant TNBC residual) Improves outcomes in residual TNBC after neoadjuvant chemo.	Neoadjuvant	Standard	Curated
Platinum agents Platinum agents remain valuable in TNBC (particularly HRD contexts).	—	Standard	Curated

Targeted therapy

Use genomic assays to decide on adjuvant chemotherapy in HR+/HER2– node-negative and select 1–3 node-positive patients undergoing upfront surgery Use genomic assays to decide on adjuvant chemotherapy in HR+/HER2– node-negative and select 1–3 node-positive patients undergoing upfront surgery.	Adjuvant	Standard	Curated
Postmenopausal HR+/HER2–: consider adjuvant bisphosphonates to reduce bone recurrence and fractures Postmenopausal HR+/HER2–: consider adjuvant bisphosphonates to reduce bone recurrence and fractures.	Adjuvant	Standard	Curated
HER2+ stage II–III: neoadjuvant taxane-based ± anthracycline + trastuzumab/pertuzumab HER2+ stage II–III: neoadjuvant taxane-based ± anthracycline + trastuzumab/pertuzumab; if residual disease, switch to adjuvant T-DM1 to complete ~1 year of anti-HER2 therapy.	Neoadjuvant	Standard	Curated
Small node-negative HER2+ (e Small node-negative HER2+ (e.g., T1a/b): consider paclitaxel + trastuzumab (TH) adjuvant de-escalation for appropriate candidates.	Adjuvant	Standard	Curated
Metastatic HER2+: first line taxane + trastuzumab + pertuzumab; second line trastuzumab deruxtecan (T-DXd) preferred; later lines Metastatic HER2+: first line taxane + trastuzumab + pertuzumab; second line trastuzumab deruxtecan (T-DXd) preferred; later lines include tucatinib + trastuzumab + capecitabine (especially with brain mets), neratinib- or lapatinib-based regimens as appropriate.	Advanced / metastatic	Standard	Curated
gBRCA-mutated, high-risk HER2– (HR+ or TNBC): consider 1 year of adjuvant olaparib per criteria gBRCA-mutated, high-risk HER2– (HR+ or TNBC): consider 1 year of adjuvant olaparib per criteria.	Adjuvant	Standard	Curated
Alpelisib for PIK3CA-mutant HR+/HER2– after AI Alpelisib for PIK3CA-mutant HR+/HER2– after AI; start glucose monitoring and rash prophylaxis (non-sedating antihistamine).	—	Standard	Curated
PARP inhibitors (olaparib/talazoparib) for gBRCA/PALB2: adjuvant (select high-risk HER2–) and metastatic PARP inhibitors (olaparib/talazoparib) for gBRCA/PALB2: adjuvant (select high-risk HER2–) and metastatic; plan for anemia monitoring and contraception.	Adjuvant	Standard	Curated
HER2 sequence (metastatic): taxane + trastuzumab/pertuzumab → trastuzumab deruxtecan (T-DXd) → tucatinib + trastuzumab + capecitabine (brain-active) → other TKIs (neratinib/lapatinib) case-by-case HER2 sequence (metastatic): taxane + trastuzumab/pertuzumab → trastuzumab deruxtecan (T-DXd) → tucatinib + trastuzumab + capecitabine (brain-active) → other TKIs (neratinib/lapatinib) case-by-case.	Advanced / metastatic	Standard	Curated
Residual disease after neoadjuvant HER2 therapy: switch to adjuvant T-DM1 to reduce recurrence risk Residual disease after neoadjuvant HER2 therapy: switch to adjuvant T-DM1 to reduce recurrence risk.	Neoadjuvant	Standard	Curated
Extended adjuvant neratinib for high-risk HR+/HER2+ after trastuzumab (diarrhea prophylaxis mandatory) — center-specific use Extended adjuvant neratinib for high-risk HR+/HER2+ after trastuzumab (diarrhea prophylaxis mandatory) — center-specific use.	Adjuvant	Standard	Curated
T-DXd active in HER2-low (IHC 1+ or 2+/ISH–) metastatic after prior lines — emphasize ILD vigilance and early drug holds if symptomatic T-DXd active in HER2-low (IHC 1+ or 2+/ISH–) metastatic after prior lines — emphasize ILD vigilance and early drug holds if symptomatic.	Advanced / metastatic	Standard	Curated
Sacituzumab govitecan Sacituzumab govitecan is a preferred later-line option in metastatic TNBC; early use of growth-factor support and loperamide reduces dose-limiting toxicity.	Advanced / metastatic	Standard	Curated
gBRCA TNBC benefits from PARP inhibitors (metastatic) and adjuvant olaparib (select early) gBRCA TNBC benefits from PARP inhibitors (metastatic) and adjuvant olaparib (select early).	Adjuvant	Standard	Curated
HER2+ CNS disease: tucatinib-based regimens HER2+ CNS disease: tucatinib-based regimens provide intracranial responses; integrate SRS/surgery with neuro-oncology.	—	Standard	Curated

Immunotherapy

High-risk early TNBC: neoadjuvant anthracycline/taxane ± platinum with pembrolizumab High-risk early TNBC: neoadjuvant anthracycline/taxane ± platinum with pembrolizumab; continue adjuvant pembrolizumab. If residual disease, add adjuvant capecitabine.	Neoadjuvant	Standard	Curated
Metastatic TNBC: PD-L1–positive → pembrolizumab + chemotherapy; later lines Metastatic TNBC: PD-L1–positive → pembrolizumab + chemotherapy; later lines include sacituzumab govitecan; gBRCA mutation → PARP inhibitor considered.	Advanced / metastatic	Standard	Curated
Pembrolizumab for high-risk early TNBC (neoadjuvant + adjuvant) improves pCR/EFS Pembrolizumab for high-risk early TNBC (neoadjuvant + adjuvant) improves pCR/EFS; in metastatic TNBC, add to chemo for PD-L1–positive disease.	Neoadjuvant	Standard	Curated
Rare MSI-H/TMB-H/NTRK fusion Rare MSI-H/TMB-H/NTRK fusion can unlock tumor-agnostic immunotherapy/TRK inhibitors; screen with broad NGS when feasible.	—	Standard	Curated

Hormonal therapy

HR+/HER2– early: endocrine therapy (tamoxifen or aromatase inhibitor) ± ovarian function suppression (OFS) based on menopausal status and risk HR+/HER2– early: endocrine therapy (tamoxifen or aromatase inhibitor) ± ovarian function suppression (OFS) based on menopausal status and risk; duration typically 5 years, extend to 7–10 years for selected higher-risk cases.	—	Standard	Curated
High-risk, node-positive HR+/HER2–: consider adjuvant abemaciclib + endocrine therapy per eligibility criteria High-risk, node-positive HR+/HER2–: consider adjuvant abemaciclib + endocrine therapy per eligibility criteria.	Adjuvant	Standard	Curated
Metastatic HR+/HER2–: endocrine therapy + CDK4/6 inhibitor Metastatic HR+/HER2–: endocrine therapy + CDK4/6 inhibitor is standard first line. On progression, personalize by biomarkers (ESR1 → SERD; PIK3CA → alpelisib + fulvestrant; AKT1/PTEN/PIK3CA → capivasertib + fulvestrant; consider everolimus combinations). Later-line ADCs (e.g., sacituzumab govitecan) are options.	Advanced / metastatic	Standard	Curated
CDK4/6 + endocrine therapy (AI or fulvestrant) CDK4/6 + endocrine therapy (AI or fulvestrant) is first-line standard for metastatic HR+/HER2–; choose agent by comorbidity (e.g., ribociclib OS data; abemaciclib diarrhea but less neutropenia).	Advanced / metastatic	Standard	Curated
Post-CDK4/6 progression: re-profile (tumor or ctDNA) Post-CDK4/6 progression: re-profile (tumor or ctDNA). ESR1 mutation → SERD strategy (e.g., fulvestrant; oral SERDs where available).	—	Standard	Curated
Capivasertib + fulvestrant improves outcomes in tumors with PI3K/AKT/PTEN alterations Capivasertib + fulvestrant improves outcomes in tumors with PI3K/AKT/PTEN alterations; counsel on diarrhea, rash, and hyperglycemia.	—	Standard	Curated
Everolimus + exemestane restores endocrine sensitivity in some AI-resistant HR+ Everolimus + exemestane restores endocrine sensitivity in some AI-resistant HR+; prevent stomatitis with dexamethasone mouthwash.	—	Standard	Curated
Adjuvant abemaciclib for high-risk node-positive HR+/HER2– improves IDFS when added to endocrine therapy (strict eligibility) Adjuvant abemaciclib for high-risk node-positive HR+/HER2– improves IDFS when added to endocrine therapy (strict eligibility).	Adjuvant	Standard	Curated
Later-line ADCs in HR+/HER2–: sacituzumab govitecan after endocrine + targeted therapies Later-line ADCs in HR+/HER2–: sacituzumab govitecan after endocrine + targeted therapies; manage neutropenia/diarrhea proactively.	—	Standard	Curated
anastrozole FDA-approved for this cancer.	—	Guideline option
tamoxifen FDA-approved for this cancer.	—	Guideline option

Established care shown from OncoForge editorial curation · reviewed September 15, 2025 — authoritative citations (NCI PDQ / FDA) are being added.

Supportive care (18)

Lymphedema program: prehab education, early PT/OT, compression fitting, and progressive weight training; prompt eval for arm swelling/tightness or axillary web syndrome.
Shoulder mobility & scar management: early ROM, myofascial techniques, and desensitization to prevent frozen shoulder and chronic pain.
Menopause symptom toolkit on endocrine therapy: non-hormonal options (SSRIs/SNRIs, gabapentin, clonidine), vaginal moisturizers/lubricants, and pelvic floor therapy; consider low-dose vaginal estrogen only after oncology review.
Sexual health: address dyspareunia, libido, and body image; consider specialized pelvic PT and counseling.
AI bone program: weight-bearing/resistance exercise, vitamin D/calcium, baseline and periodic DEXA; consider adjuvant bisphosphonates (postmenopausal) or denosumab with dental clearance.
Cardio-oncology: manage BP, lipids, diabetes; baseline CV risk assessment before anthracyclines/HER2 therapy; lifestyle coaching for activity, weight, and sleep.
Return-to-work & cognitive rehab: graded return plan, fatigue pacing, occupational therapy, and ‘chemo-brain’ strategies (sleep hygiene, cognitive exercises).
Alopecia and neuropathy mitigation: scalp cooling during sensitive chemo; frozen gloves/booties during taxanes to reduce CIPN and nail toxicity.
Stomatitis prevention: steroid mouthwash with everolimus; salt/bicarbonate rinses broadly; early dental issues triage to avoid ONJ when on bone agents.
GI playbooks: diarrhea (abemaciclib/capecitabine/sacituzumab) start loperamide early; nausea bundles with evidence-based antiemetics; constipation prevention with opioids/antiemetics.
Pulmonary vigilance: new cough/dyspnea/fever on T-DXd or everolimus → urgent ILD/pneumonitis evaluation and drug hold.
Dermatologic care: alpelisib/capivasertib rash prophylaxis (non-sedating antihistamines), urea-based emollients; HFS care on capecitabine.
Metabolic monitoring: proactive glucose/A1c and dietitian input with alpelisib/capivasertib; avoid unsupervised fasting in underweight/sarcopenic patients.
Multimodal analgesia: NSAIDs/acetaminophen, neuropathic agents (duloxetine for CIPN), interventional options when needed; early palliative/supportive care improves QoL.
Sleep, anxiety, and mood: CBT-I, mindfulness, exercise; screen for depression/PTSD and treat promptly.
Vaccination plan: inactivated vaccines per guidelines; avoid live vaccines during cytotoxic therapy/biologics; consider HBV screening in at-risk patients.
Port care: educate on infection/DVT signs; coordinate holds around procedures (anticoagulants, bone agents).
Navigation and financial counseling: transportation, work leave, medication access, and clinical trial matching to reduce care gaps.

Investigational & adjunct compounds — detail (76)

Meta-analysis (29)

Named in the literature

Lab / animal only

"Tested in people" rows show the highest trial phase found in that compound's cited human studies (Phase I–IV; "phase not reported" = a human study with no phase tag). "Studied" = named in the cited literature for this cancer. "FDA ✓" = FDA-approved for this cancer; "off-label" = an FDA-approved drug used outside its approved indications (per openFDA). Not a claim that anything works.