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Meta-Analysis
. 2021 Dec 10;39(35):3938-3958.
doi: 10.1200/JCO.21.01374. Epub 2021 Jul 29.

Chemotherapy and Targeted Therapy for Patients With Human Epidermal Growth Factor Receptor 2-Negative Metastatic Breast Cancer That is Either Endocrine-Pretreated or Hormone Receptor-Negative: ASCO Guideline Update

Beverly Moy  1 , R Bryan Rumble  2 , Steven E Come  3 , Nancy E Davidson  4 , Angelo Di Leo  5   6 , Julie R Gralow  7 , Gabriel N Hortobagyi  8 , Douglas Yee  9 , Ian E Smith  10 , Mariana Chavez-MacGregor  8 , Rita Nanda  11 , Heather L McArthur  12 , Laura Spring  1 , Katherine E Reeder-Hayes  13 , Kathryn J Ruddy  14 , Paul S Unger  15 , Shaveta Vinayak  16 , William J Irvin Jr  17 , Avan Armaghani  18 , Michael A Danso  19 , Natalie Dickson  20 , Sophie S Turner  21 , Cheryl L Perkins  22 , Lisa A Carey  13
Affiliations
Meta-Analysis

Chemotherapy and Targeted Therapy for Patients With Human Epidermal Growth Factor Receptor 2-Negative Metastatic Breast Cancer That is Either Endocrine-Pretreated or Hormone Receptor-Negative: ASCO Guideline Update

Beverly Moy et al. J Clin Oncol. .

Abstract

Purpose: This guideline updates recommendations of the ASCO guideline on chemotherapy and targeted therapy for patients with human epidermal growth factor receptor 2-negative metastatic breast cancer (MBC) that is either endocrine-pretreated or hormone receptor (HR)-negative.

Methods: An Expert Panel conducted a targeted systematic literature review guided by a signals approach to identify new, potentially practice-changing data that might translate into revised guideline recommendations.

Results: The Expert Panel reviewed abstracts from the literature review and retained 14 articles.

Recommendations: Patients with triple-negative, programmed cell death ligand-1-positive MBC may be offered the addition of immune checkpoint inhibitor to chemotherapy as first-line therapy. Patients with triple-negative, programmed cell death ligand-1-negative MBC should be offered single-agent chemotherapy rather than combination chemotherapy as first-line treatment, although combination regimens may be offered for life-threatening disease. Patients with triple-negative MBC who have received at least two prior therapies for MBC should be offered treatment with sacituzumab govitecan. Patients with triple-negative MBC with germline BRCA mutations previously treated with chemotherapy may be offered a poly (ADP-ribose) polymerase inhibitor rather than chemotherapy. Patients with HR-positive human epidermal growth factor receptor 2-negative MBC for whom chemotherapy is being considered should be offered single-agent chemotherapy rather than combination chemotherapy, although combination regimens may be offered for highly symptomatic or life-threatening disease. Patients with HR-positive MBC with disease progression on an endocrine agent may be offered treatment with either endocrine therapy with or without targeted therapy or single-agent chemotherapy. Patients with HR-positive MBC with germline BRCA mutations no longer benefiting from endocrine therapy may be offered a poly (ADP-ribose) polymerase inhibitor rather than chemotherapy. No recommendation regarding when a patient's care should be transitioned to hospice or best supportive care alone is possible.Additional information is available at www.asco.org/breast-cancer-guidelines.

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Conflict of interest statement

Beverly MoyConsulting or Advisory Role: MOTUSResearch Funding: Puma Biotechnology Steven E. ComeResearch Funding: AstraZenecaOpen Payments Link: https://openpaymentsdata.cms.gov/physician/163830/summary Angelo Di LeoHonoraria: Roche, Novartis, Pfizer, AstraZeneca, Eisai, Lilly, Celgene, AmgenConsulting or Advisory Role: Roche, Novartis, Pfizer, AstraZeneca, Lilly, Celgene, Puma Biotechnology, Ipsen, Genentech, Amgen, Seattle Genetics, Genomic Health, Athenex, Daiichi SankyoTravel, Accommodations, Expenses: Roche, Pfizer, Celgene, Novartis Julie R. GralowConsulting or Advisory Role: Genentech, AstraZeneca, Hexal, Puma Biotechnology, Roche, Novartis, Seagen, Genomic Health Gabriel N. HortobagyiConsulting or Advisory Role: NovartisResearch Funding: NovartisTravel, Accommodations, Expenses: Novartis Douglas YeeStock and Other Ownership Interests: Apogen BiotechnologiesHonoraria: Puma Biotechnology, Daiichi Sankyo, Boehringer IngelheimConsulting or Advisory Role: Martell diagnosticResearch Funding: Boehringer IngelheimOpen Payments Link: https://openpaymentsdata.cms.gov/physician/636443/summary Ian E. SmithStock and Other Ownership Interests: Perci HealthHonoraria: Eisai, AstraZeneca, Genomic Health, PfizerConsulting or Advisory Role: Roche, AstraZeneca, Eisai, Pfizer, Genomic HealthTravel, Accommodations, Expenses: Genomic Health Mariana Chavez-MacGregorEmployment: MD Anderson Physician's NetworkHonoraria: Pfizer, EisaiConsulting or Advisory Role: Roche/Genentech, AstraZeneca, Novartis, Pfizer, Asofar, Genomic Health, Roche/GenentechResearch Funding: NovartisExpert Testimony: Abbott Laboratories, PfizerTravel, Accommodations, Expenses: PfizerOther Relationship: RocheUncompensated Relationships: Legacy Healthcare Services, The Hope Foundation Rita NandaConsulting or Advisory Role: Merck, Genentech/Roche, Pfizer, Macrogenics, Aduro Biotech, Ionis Pharmaceuticals, Immunomedics, OncoSec, Cardinal Health, Seattle Genetics, Fujifilm, Clovis Oncology, G1 TherapeuticsResearch Funding: Corcept Therapeutics, Celgene, Merck, Seattle Genetics, Genentech/Roche, Odonate Therapeutics, Pfizer, AstraZeneca, Immunomedics, OncoSec, Arvinas, Taiho OncologyOther Relationship: G1 Therapeutics Heather L. McArthurConsulting or Advisory Role: Merck, Lilly, Immunomedics, Pfizer, Genentech, Bristol Myers Squibb, AstraZeneca , Daiichi Sankyo, Seattle Genetics, Genomic Health, Puma BiotechnologyResearch Funding: Bristol Myers Squibb, ZIOPHARM Oncology, Lilly, MerckTravel, Accommodations, Expenses: Merck, Spectrum Pharmaceuticals, Lilly, Amgen, Puma Biotechnology, Immunomedics, Genentech, Pfizer, AstraZeneca, Bristol Myers Squibb, DAVA PharmaceuticalsOther Relationship: Lilly, Genomic Health Laura SpringConsulting or Advisory Role: Novartis, Puma Biotechnology, Lumicell, AvrobioResearch Funding: Tesaro, MerckTravel, Accommodations, Expenses: Merck, Tesaro Katherine E. Reeder-HayesResearch Funding: Pfizer Kathryn J. RuddyResearch Funding: MedtronicPatents, Royalties, Other Intellectual Property: Spouse and Mayo Clinic have filed patents related to the application of artificial intelligence to the electrocardiogram for diagnosis and risk stratification, and Spouse and Mayo Clinic are involved in a potential equity/royalty relationship with AliveCor Shaveta VinayakConsulting or Advisory Role: OncoSecResearch Funding: OncoSec, Seattle Genetics, PfizerTravel, Accommodations, Expenses: OncoSec William J. Irvin JrResearch Funding: Merck, Altor BioScience, Odonate Therapeutics, Boston Biomedical, Novartis, Pfizer, Seattle Genetics, AstraZeneca Michael A. DansoHonoraria: AmgenConsulting or Advisory Role: Novartis, Pfizer, Immunomedics, Seattle Genetics Natalie DicksonEmployment: Tennessee OncologyConsulting or Advisory Role: Via Oncology, AbbVie, CignaResearch Funding: Bristol Myers SquibbTravel, Accommodations, Expenses: Flatiron Health Sophie S. TurnerEmployment: IQVIA Cheryl PerkinsEmployment: Medscape Lisa A. CareyResearch Funding: Syndax, Immunomedics, Novartis, NanoString Technologies, AbbVie, Seattle Genetics, VeracytePatents, Royalties, Other Intellectual Property: Royalty-sharing agreement, investorship interest in licensed IP to startup company, Falcon Therapeutics, that is designing neural stem-cell–based therapy for glioblastoma multiformeUncompensated Relationships: Sanofi, Novartis, G1 Therapeutics, Genentech/Roche, GlaxoSmithKline, AstraZeneca/Daiichi Sankyo, Aptitude Health, Exact Sciences, EisaiOpen Payments Link: https://openpaymentsdata.cms.gov/physician/179671No other potential conflicts of interest were reported.

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