Systemic Treatment of Patients With Metastatic Breast Cancer: ASCO Resource鈥揝tratified Guideline

鈥� An ASCO Reading Room selection

June 4, 2024

Sana Al Sukhun, MD, MSc, FASCO, Sarah Temin, MSPH, Carlos H. Barrios, MD, Nicoleta Zenovia Antone, MD, Yanin Chavarri Guerra, MD, MSc, Mariana Chavez-MacGregor, MD, MSc, FASCO, Rakesh Chopra, MD, Michael A. Danso, MD, FASCO, Henry Leonidas Gomez, MD, PhD, N鈥橠a Marcelin Homian, MD, Alaa Kandil, MD, Benda Kithaka, Bogda Koczwara, MD, Beverly Moy, MD, FASCO, MPH, Gertrude Nakigudde, Fernando Enrique Petracci, MD, Hope S. Rugo, MD, FASCO, Nagi S. El Saghir, MD, FASCO, and Banu K. Arun, MD

JCO Global Oncology

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Below is the abstract of the article.

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Purpose

To 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.

Methods

A multidisciplinary, multinational panel reviewed existing ASCO guidelines and conducted modified ADAPTE and formal consensus processes.

Results

Four published resource-agnostic guidelines were adapted for resource-constrained settings; informing two rounds of formal consensus; recommendations received ≥75% agreement.

Recommendations

Clinicians 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 . 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.

Read an interview about the study here and expert commentary about it here.

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Systemic Treatment of Patients With Metastatic Breast Cancer: ASCO Resource鈥揝tratified Guideline

Primary Source

JCO Global Oncology

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