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Endocrine Treatment and Targeted Therapy for Hormone Receptor–Positive, Human Epidermal Growth Factor Receptor 2–Negative Metastatic Breast Cancer: ASCO Guideline Update
- Source :
- Journal of clinical oncology : official journal of the American Society of Clinical Oncology, vol 39, iss 35, J Clin Oncol
- Publication Year :
- 2021
- Publisher :
- American Society of Clinical Oncology (ASCO), 2021.
-
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 .
- Subjects :
- 0301 basic medicine
Oncology
Cancer Research
Receptor, ErbB-2
medicine.medical_treatment
Systemic therapy
Targeted therapy
ErbB-2
0302 clinical medicine
Receptors
Molecular Targeted Therapy
skin and connective tissue diseases
Human Epidermal Growth Factor Receptor 2
Progesterone
Cancer
Tumor
Prognosis
Metastatic breast cancer
Receptors, Estrogen
Hormone receptor
6.1 Pharmaceuticals
030220 oncology & carcinogenesis
ASCO Special Articles
Practice Guidelines as Topic
Female
Receptors, Progesterone
Receptor
medicine.medical_specialty
2019-20 coronavirus outbreak
Antineoplastic Agents, Hormonal
Clinical Sciences
Oncology and Carcinogenesis
Breast Neoplasms
Antineoplastic Agents
03 medical and health sciences
Clinical Research
Internal medicine
Breast Cancer
Biomarkers, Tumor
medicine
Humans
Endocrine system
Oncology & Carcinogenesis
neoplasms
Hormonal
business.industry
Evaluation of treatments and therapeutic interventions
Guideline
medicine.disease
Estrogen
030104 developmental biology
business
Biomarkers
Subjects
Details
- ISSN :
- 15277755 and 0732183X
- Volume :
- 39
- Database :
- OpenAIRE
- Journal :
- Journal of Clinical Oncology
- Accession number :
- edsair.doi.dedup.....99e630d5df3b3a8bef6137fbb799786d
- Full Text :
- https://doi.org/10.1200/jco.21.01392