Endocrine treatment and targeted therapy for hormone receptor–positive, human epidermal growth factor receptor 2–negative metastatic breast cancer: ASCO guideline update

Burstein, Harold J, Somerfield, Mark R, Barton, Debra L, Dorris, Ali, Fallowfield, Lesley J, Jain, Dharamvir, Johnston, Stephen R D, Korde, Larissa A, Litton, Jennifer K, Macrae, Erin R, Peterson, Lindsay L, Vikas, Praveen, Yung, Rachel L and Rugo, Hope S (2021) Endocrine treatment and targeted therapy for hormone receptor–positive, human epidermal growth factor receptor 2–negative metastatic breast cancer: ASCO guideline update. Journal of Clinical Oncology. pp. 1-19. ISSN 0732-183X

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Abstract

PURPOSE
To update recommendations of the ASCO systemic therapy for hormone receptor (HR)-positive metastatic breast cancer (MBC) guideline.

METHODS
An Expert Panel conducted a systematic review to identify new, potentially practice-changing data.

RESULTS
Fifty-one articles met eligibility criteria and form the evidentiary basis for the recommendations.

RECOMMENDATIONS
Alpelisib in combination with endocrine therapy (ET) should be offered to postmenopausal patients, and to male patients, with HR-positive, human epidermal growth factor receptor 2 (HER2)-negative, PIK3CA-mutated, ABC, or MBC following prior endocrine therapy with or without a cyclin-dependent kinase (CDK) 4/6 inhibitor. Clinicians should use next-generation sequencing in tumor tissue or cell-free DNA in plasma to detect PIK3CA mutations. If no mutation is found in cell-free DNA, testing in tumor tissue, if available, should be used as this will detect a small number of additional patients with PIK3CA mutations. There are insufficient data at present to recommend routine testing for ESR1 mutations to guide therapy for HR-positive, HER2-negative MBC. For BRCA1 or BRCA2 mutation carriers with metastatic HER2-negative breast cancer, olaparib or talazoparib should be offered in the 1st-line through 3rd-line setting. A nonsteroidal aromatase inhibitor (AI) and a CDK4/6 inhibitor should be offered to postmenopausal women with treatment-naïve HR-positive MBC. Fulvestrant and a CDK4/6 inhibitor should be offered to patients with progressive disease during treatment with AIs (or who develop a recurrence within 1 year of adjuvant AI therapy) with or without one line of prior chemotherapy for metastatic disease, or as first-line therapy. Treatment should be limited to those without prior exposure to CDK4/6 inhibitors in the metastatic setting.

Additional information can be found at www.asco.org/breast-cancer-guidelines

Item Type: Article
Schools and Departments: Brighton and Sussex Medical School > Sussex Health Outcomes Research & Education in Cancer (SHORE-C)
SWORD Depositor: Mx Elements Account
Depositing User: Mx Elements Account
Date Deposited: 04 Aug 2021 07:31
Last Modified: 04 Aug 2021 07:31
URI: http://sro.sussex.ac.uk/id/eprint/100918

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