ASCO Issues Two New Guidelines on Treating Patients With Advanced, HER2-Positive Breast Cancer


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ASCO recently issued two clinical practice guidelines on treating women with advanced, HER2-positive breast cancer. The first guideline lists the appropriate systemic therapies for women newly diagnosed with advanced disease and those whose early-stage disease progressed to advanced cancer. The second guideline provides recommendations for treating brain metastases in women with HER2-positive advanced breast cancer.

Watch future issues of The ASCO Post for a comprehensive report on these new guidelines.

Systemic Therapy for Advanced, HER2-Positive Breast Cancer 

ASCO’s new guideline provides evidence-based recommendations for using systemic targeted therapies in treating advanced (inoperable locally advanced and metastatic), HER2-positive breast cancer. The recommendations will help standardize care and maximize the potential benefit from HER2-targeted therapies. 

Key Recommendations

First-line therapy: combination of chemotherapy, trastuzumab (Herceptin) and pertuzumab (Perjeta). For select patients, such as those with contraindications and/or slow-growing hormone receptor–positive cancer, hormonal therapy administered with or without either trastuzumab or lapatinib (Tykerb) may be substituted for a chemotherapy-based HER2-targeted regimen because it may have fewer side effects. However, hormonal therapy is not appropriate for all patients with advanced, hormone receptor–positive breast cancer and it has not been associated with a survival benefit in this setting.

Second-line therapy: ado-trastuzu­mab emtansine (Kadcyla), formerly known as T-DM1

Third-line line therapy and beyond: treatment depends on what patients have received in the first- and second-line settings. Options may include ado-trastuzu­mab emtansine, hormonal therapy or chemotherapy with trastuzumab and in some cases with lapatinib, the combination of trastuzumab and lapatinib, or a pertuzu­mab-based regimen if the patient had not previously received pertuzumab.

Consensus Recommendations for Treating Brain Metastases

ASCO has released a clinical practice guideline providing consensus-based recommendations for use of local and systemic therapies in patients with HER2-positive breast cancer that has spread to the brain. 

Key Recommendations

For patients with favorable prognosis for survival, surgery and/or radiotherapy are recommended, depending on the size and number of metastases, resectability, and symptoms.

For patients with a poor prognosis for survival, options include surgery, whole-brain radiation therapy, and systemic therapies with some evidence of activity in the setting of brain metastases, such as lapatinib and capecitabine. 

Additional options include best supportive care, enrollment in a clinical trial, and/or palliative care. ■

The guideline, Systemic Therapy for Patients with Advanced HER2-Positive Breast Cancer:  American Society of Clinical Oncology Clinical Practice Guideline, was published in the Journal of Clinical Oncology, May 5, 2014.


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