Systemic Therapy for Patients With Advanced Human Epidermal Growth Factor Receptor 2-Positive Breast Cancer: American Society of Clinical Oncology Clinical Practice Guideline

• Published in: Journal of clinical oncology Vol. 32; no. 19; pp. 2078 - 2099
• Main Authors: GIORDANO, Sharon H, TEMIN, Sarah, LIN, Nancy U, MODI, Shanu, PATT, Debra A, PEREZ, Edith A, PERLMUTTER, Jane, RAMAKRISHNA, Naren, WINER, Eric P, KIRSHNER, Jeffrey J, CHANDARLAPATY, Sarat, CREWS, Jennie R, DAVIDSON, Nancy E, ESTEVA, Francisco J, GONZALEZ-ANGULO, Ana M, KROP, Ian, LEVINSON, Jennifer
• Format: Journal Article
• Language: English
• Published: Alexandria, VA American Society of Clinical Oncology 01-07-2014
• Subjects: Ado-Trastuzumab Emtansine; Anastrozole; Antibodies, Monoclonal, Humanized - administration & dosage; Antineoplastic Agents, Hormonal - administration & dosage; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; ASCO Special; Biological and medical sciences; Biomarkers, Tumor - analysis; Breast Neoplasms - chemistry; Breast Neoplasms - drug therapy; Breast Neoplasms - mortality; Breast Neoplasms - pathology; Clinical Trials as Topic - standards; Comorbidity; Docetaxel; Drug Administration Schedule; Evidence-Based Medicine; Female; Gynecology. Andrology. Obstetrics; Health Status Disparities; Healthcare Disparities; Humans; Lapatinib; Letrozole; Mammary gland diseases; Maytansine - administration & dosage; Maytansine - analogs & derivatives; Medical sciences; Molecular Targeted Therapy - methods; Multiple tumors. Solid tumors. Tumors in childhood (general aspects); Nitriles - administration & dosage; Quinazolines - administration & dosage; Receptor, ErbB-2 - analysis; Receptors, Estrogen - analysis; Receptors, Progesterone - analysis; Societies, Medical; Taxoids - administration & dosage; Trastuzumab; Treatment Outcome; Triazoles - administration & dosage; Tumors; United States; United States; North America; America; Human; Mammary gland diseases; Breast disease; Cancerology; Treatment; Professional practice; Advanced stage; Breast cancer; Malignant tumor; Recommendation; Human Epidermal growth factor Receptor 2; Cancer
• ISSN: 0732-183X; 1527-7755
• DOI: 10.1200/JCO.2013.54.0948

To provide evidence-based recommendations to practicing oncologists and others on systemic therapy for patients with human epidermal growth factor receptor 2 (HER2) -positive advanced breast cancer.
The American Society of Clinical Oncology convened a panel of medical oncology, radiation oncology, guideline implementation, and advocacy experts and conducted a systematic literature review from January 2009 to October 2012. Outcomes of interest included overall survival, progression-free survival (PFS), and adverse events.
A total of 16 trials met the systematic review criteria. The CLEOPATRA trial found survival and PFS benefits for docetaxel, trastuzumab, and pertuzumab in first-line treatment, and the EMILIA trial found survival and PFS benefits for trastuzumab emtansine (T-DM1) in second-line treatment. T-DM1 also showed a third-line PFS benefit. One trial reported on duration of HER2-targeted therapy, and three others reported on endocrine therapy for patients with HER-positive advanced breast cancer.
HER2-targeted therapy is recommended for patients with HER2-positive advanced breast cancer, except for those with clinical congestive heart failure or significantly compromised left ventricular ejection fraction, who should be evaluated on a case-by-case basis. Trastuzumab, pertuzumab, and taxane for first-line treatment and T-DM1 for second-line treatment are recommended. In the third-line setting, clinicians should offer other HER2-targeted therapy combinations or T-DM1 (if not previously administered) and may offer pertuzumab, if the patient has not previously received it. Optimal duration of chemotherapy is at least 4 to 6 months or until maximum response, depending on toxicity and in the absence of progression. HER2-targeted therapy can continue until time of progression or unacceptable toxicities. For patients with HER2-positive and estrogen receptor-positive/progesterone receptor-positive breast cancer, clinicians may recommend either standard first-line therapy or, for selected patients, endocrine therapy plus HER2-targeted therapy or endocrine therapy alone.