ASCO Updates Systemic Therapy Guideline for Advanced HER2-Positive Breast Cancer

08/20/18

The American Society of Clinical Oncology (ASCO) released an update to the guideline for systemic therapy for patients with human epidermal growth factor receptor 2 (HER2)-positive metastatic breast cancer.

The update is designed to provide oncologists, other health care practitioners, patients, and caregivers with current recommendations for optimal management of patients with this disease.

Authors of the guideline conducted a systemic review of the literature and relevant evidence was assessed for inclusion in the updated guideline. The resulting guideline is published in the Journal of Clinical Oncology (August 2018;14[8]:501-504).

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The recommendations that are strongly backed by the panel for the guideline update are as follows:

  • Clinicians should recommend HER2-targeted therapy–based combinations for first-line treatment, except for highly selected patients with estrogen receptor–positive or progesterone receptor–positive and HER2-positive disease, for whom clinicians may use endocrine therapy alone.
  • If a patient’s HER2-positive advanced breast cancer has progressed during or after first-line HER2-targeted therapy, clinicians should recommend second-line HER2-targeted therapy– based treatment.
  • Clinicians should recommend the combination of trastuzumab, pertuzumab, and a taxane for first-line treatment, unless the patient has a contraindication to taxanes.
  • If a patient’s HER2-positive advanced breast cancer has progressed during or after first-line HER2-targeted therapy, clinicians should recommend trastuzumab emtansine (T-DM1) as second-line treatment.
  • If a patient’s HER2-positive advanced breast cancer has progressed during or after second-line or greater HER2-targeted therapy, but she has not received T-DM1, clinicians should offer T-DM1.
  • If a patient finished trastuzumab-based adjuvant treatment  12 months before recurrence, clinicians should follow the first-line HER2-targeted therapy–based treatment recommendations.
  • If a patient’s cancer is hormone receptor positive and HER2–positive, clinicians may recommend HER2-targeted therapy plus chemotherapy.

Authors of the guideline also included a qualifying statement: “Although clinicians may discuss using endocrine therapy with or without HER2-targeted therapy, the majority of patients will still receive chemotherapy plus HER2-targeted therapy.”—Zachary Bessette