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Systemic Treatment of Patients With Metastatic Breast Cancer: ASCO Resource–Stratified Guideline

Authors :
Sana Al Sukhun
Sarah Temin
Carlos H. Barrios
Nicoleta Zenovia Antone
Yanin Chavarri Guerra
Mariana Chavez-MacGregor
Rakesh Chopra
Michael A. Danso
Henry Leonidas Gomez
N’Da Marcelin Homian
Alaa Kandil
Benda Kithaka
Bogda Koczwara
Beverly Moy
Gertrude Nakigudde
Fernando Enrique Petracci
Hope S. Rugo
Nagi S. El Saghir
Banu K. Arun
Source :
JCO Global Oncology, Vol , Iss 10 (2024)
Publication Year :
2024
Publisher :
American Society of Clinical Oncology, 2024.

Abstract

PURPOSETo guide clinicians and policymakers in three global resource-constrained settings on treating patients with metastatic breast cancer (MBC) when Maximal setting–guideline recommended treatment is unavailable.METHODSA multidisciplinary, multinational panel reviewed existing ASCO guidelines and conducted modified ADAPTE and formal consensus processes.RESULTSFour published resource-agnostic guidelines were adapted for resource-constrained settings; informing two rounds of formal consensus; recommendations received ≥75% agreement.RECOMMENDATIONSClinicians should recommend treatment according to menopausal status, pathological and biomarker features when quality results are available. In first-line, for hormone receptor (HR)–positive MBC, when a non-steroidal aromatase inhibitor and CDK 4/6 inhibitor combination is unavailable, use hormonal therapy alone. For life-threatening disease, use single-agent chemotherapy or surgery for local control. For premenopausal patients, use ovarian suppression or ablation plus hormone therapy in Basic settings. For human epidermal growth factor receptor 2 (HER2)–positive MBC, if trastuzumab, pertuzumab, and chemotherapy are unavailable, use trastuzumab and chemotherapy; if unavailable, use chemotherapy. For HER2-positive, HR-positive MBC, use standard first-line therapy, or endocrine therapy if contraindications. For triple-negative MBC with unknown PD-L1 status, or if PD-L1–positive and immunotherapy unavailable, use single-agent chemotherapy. For germline BRCA1/2 mutation–positive MBC, if poly(ADP-ribose) polymerase inhibitor is unavailable, use hormonal therapy (HR-positive MBC) and chemotherapy (HR-negative MBC). In second-line, for HR-positive MBC, Enhanced setting recommendations depend on prior treatment; for Limited, use tamoxifen or chemotherapy. For HER2-positive MBC, if trastuzumab deruxtecan is unavailable, use trastuzumab emtansine; if unavailable, capecitabine and lapatinib; if unavailable, trastuzumab and/or chemotherapy (hormonal therapy alone for HR-positive MBC).Additional information is available at www.asco.org/resource-stratified-guidelines. It is ASCO's view that healthcare providers and system decision-makers should be guided by the recommendations for the highest stratum of resources available. The guideline is intended to complement but not replace local guidelines.

Details

Language :
English
ISSN :
26878941
Volume :
10
Issue :
10
Database :
Directory of Open Access Journals
Journal :
JCO Global Oncology
Publication Type :
Academic Journal
Accession number :
edsdoj.9bac98206ff545daa7a8335a19ffb04e
Document Type :
article
Full Text :
https://doi.org/10.1200/GO.23.00285