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Review
. 2022 May;193(1):1-20.
doi: 10.1007/s10549-022-06522-6. Epub 2022 Feb 28.

A Canadian national guideline on the neoadjuvant treatment of invasive breast cancer, including patient assessment, systemic therapy, and local management principles

Sonal Gandhi  1 , Muriel Brackstone  2 , Nicole J Look Hong  3 , Debjani Grenier  4 , Elysia Donovan  5 , Fang-I Lu  6 , Mia Skarpathiotakis  7 , Justin Lee  8 , Jean-Francois Boileau  9 , Francisco Perera  10 , Christine Simmons  11 , Anil A Joy  12 , William T Tran  5 ; Canadian National Neoadjuvant Breast Cancer Consortium
Collaborators, Affiliations
Review

A Canadian national guideline on the neoadjuvant treatment of invasive breast cancer, including patient assessment, systemic therapy, and local management principles

Sonal Gandhi et al. Breast Cancer Res Treat. 2022 May.

Abstract

Purpose: The neoadjuvant treatment of breast cancer (NABC) is a rapidly changing area that benefits from guidelines integrating evidence with expert consensus to help direct practice. This can optimize patient outcomes by ensuring the appropriate use of evolving neoadjuvant principles.

Methods: An expert panel formulated evidence-based practice recommendations spanning the entire neoadjuvant breast cancer treatment journey. These were sent for practice-based consensus across Canada using the modified Delphi methodology, through a secure online survey. Final recommendations were graded using the GRADE criteria for guidelines. The evidence was reviewed over the course of guideline development to ensure recommendations remained aligned with current relevant data.

Results: Response rate to the online survey was almost 30%; representation was achieved from various medical specialties from both community and academic centres in various Canadian provinces. Two rounds of consensus were required to achieve 80% or higher consensus on 59 final statements. Five additional statements were added to reflect updated evidence but not sent for consensus.

Conclusions: Key highlights of this comprehensive Canadian guideline on NABC include the use of neoadjuvant therapy for early stage triple negative and HER2 positive breast cancer, with subsequent adjuvant treatments for patients with residual disease. The use of molecular signatures, other targeted adjuvant therapies, and optimal response-based local regional management remain actively evolving areas. Many statements had evolving or limited data but still achieved high consensus, demonstrating the utility of such a guideline in helping to unify practice while further evidence evolves in this important area of breast cancer management.

Keywords: Breast cancer; Consensus; Guideline; Neoadjuvant.

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Conflict of interest statement

Primary Authors: SG—advisory board (Roche, Novartis, Lilly, Pfizer, Exact Science, and Agendia). External Reviewer: JFB—speaking honoraria (Roche, Novartis, Genomic Health, Pfizer, Allergan and Merck), consultant (Roche), Grants (Roche, Novartis, Pfzier, Abbvie), advisory board (Roche, Genomic Health, Nanostring Technologies, Pfizer, Lilly, Novartis and Merck). None of these COI were deemed impactful on the development or review of specific guideline recommendations.

Figures

Fig. 1
Fig. 1
Literature search consort diagram. There were 78 studies included for analysis after applying the inclusion and exclusion criteria
Fig. 2
Fig. 2
Modified-Delphi Process. Consensus statements were developed by the steering committee based on evidence and relevant discussion. Statements were reviewed by 5 additional experts, finalized, and emailed as a secure online survey. Two rounds were required for consensus of > 79% for all statements
Fig. 3
Fig. 3
Summary of Expert Respondents' Information. A Participants Clinical Specialty. B Years of Experience. C Practice Setting. D Geographic Region
See this image and copyright information in PMC

References

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