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Guideline
. 2024 Oct 24;31(11):6536-6567.
doi: 10.3390/curroncol31110484.

Guidance for Canadian Breast Cancer Practice: National Consensus Recommendations for the Systemic Treatment of Patients with HER2+ Breast Cancer in Both the Early and Metastatic Setting

Mita Manna  1 , Karen A Gelmon  2 , Jean-François Boileau  3 , Christine Brezden-Masley  4 , Jeffrey Q Cao  5 , Katarzyna J Jerzak  6 , Ipshita Prakash  3 , Sandeep Sehdev  7 , Christine Simmons  2 , Nathaniel Bouganim  8 , Muriel Brackstone  9 , David W Cescon  10 , Stephen Chia  2 , Ian S Dayes  11 , Scott Edwards  12 , John Hilton  7 , Anil Abraham Joy  13 , Kara Laing  12 , Marc Webster  5 , Jan-Willem Henning  5
Affiliations
Guideline

Guidance for Canadian Breast Cancer Practice: National Consensus Recommendations for the Systemic Treatment of Patients with HER2+ Breast Cancer in Both the Early and Metastatic Setting

Mita Manna et al. Curr Oncol. .

Abstract

Human epidermal growth factor receptor 2-positive (HER2+) breast cancer is an aggressive subtype of breast cancer associated with a poor prognosis when sub-optimally treated. Recent advances include new and effective targeted therapies that have significantly improved outcomes for patients. Despite these advances, there are significant gaps across Canada, underscoring the need for evidence-based consensus guidance to inform treatment decisions. Addressing these gaps is crucial to ensuring that effective therapies are integrated into clinical practice, so as to improve the lives of patients affected by this aggressive form of breast cancer. The Research Excellence, Active Leadership (REAL) Canadian Breast Cancer Alliance is a standing nucleus committee of clinical-academic oncologists across Canada and Breast Cancer Canada, a patient organization. The mandate of this group is to provide evidence-based guidance on best practices in the management of patients with breast cancer. These consensus recommendations were developed using a modified Delphi process with up to three rounds of anonymous voting. Consensus was defined a priori as ≥75% of voters agreeing with the recommendation as written. There are 9 recommendations in the early setting; 7 recommendations in the metastatic setting; and 10 recommendations for patients with brain metastases.

Keywords: Canadian consensus recommendations; HER2+; REAL Alliance; breast cancer; evidence-based.

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Conflict of interest statement

M.M.: Advisory boards—Advanced Accelerator Applications, AstraZeneca, Eli Lilly, Gilead Sciences, Ipsen, Knight Therapeutics, Novartis, Pfizer, Daiichi Sankyo, Roche. Speaker bureau/honoraria—McGill University, AstraZeneca, Bristol, Myers Squibb, Eli Lilly, Gilead Sciences, Knight Therapeutics, Merck, Novartis, Pfizer. Grants/research support—AstraZeneca, Royal University Hospital Women Leading Philanthropy Grant; K.A.G.: Honoraria—Novartis, Merck, Celuity, Astra Zeneca, Eli Lilly, Pfizer, Gilead, Seagan, City of Hope. Speaker bureau/honoraria—Merck, AstraZeneca, CBCN, Novartis. Grants/research support—CIHR, McGill, BMS, Pfizer. Other—AstraZeneca, City of Hope Hospital, IDMC participation, Parexel, Pfizer; J-F.B.: Honoraria—Roche, Genomic Health, NanoString Technologies, Pfizer, Lilly, Novartis, Merck and AstraZeneca. Speaker bureau/honoraria—Roche, Novartis, Genomic Health, Pfizer, Allergan, Merck and AstraZeneca. Grants/research support—Institution received research funding (institution PI): Roche, Novartis, Pfizer, AbbVie, Merck, RNA Diagnostics Inc, Lilly, Bristol Myers Squibb, Genomic Health and AstraZeneca. Other—Steering committee: MAC.39 (CCTG) and DESTINY BREAST-11 (AstraZeneca); C.B-M.: Honoraria—Amgen, Astellas, Biogene, Astra Zeneca, BMS, Rli Lolly, Gilead Sciences, Hoffman La-Roche, Knight, Merck, Novartis, Pfizer. Speaker bureau/honoraria—Amgen, Astellas, Biogene, Astra Zeneca, BMS, Rli Lolly, Gilead Sciences, Hoffman La-Roche, Knight, Merck, Novartis, Pfizer. Grants/research support—Astra Zeneca, Astellas, Pfizer, Novartis, Gilead Sciences; J.C.: Speaker bureau/honoraria—Roche, Pfizer, Novartis, AstraZeneca, Well Doc Alberta, Merck, La Roche-Posay, Knight, Seagen, Oncology Education, Gilead. Grants/research support—CIHR; K.J.J.: Advisory boards—Amgen, AstraZeneca, Apo Biologix, Daiichi Sanchyo, Eli Lilly, Esai, Genomic Health, Gilead Sciences, Knight Therapeutics, Merck, Myriad Genetics Inc, Pfizer, Roche, Seagen, Novartis, Organon. Speaker bureau/honoraria—Amgen, AstraZeneca, Apo Biologix, Daiichi Sanchyo, Eli Lilly, Esai, Genomic Health, Gilead Sciences, Knight Therapeutics, Merck, Myriad Genetics Inc, Pfizer, Roche, Seagen, Novartis, Organon. Grants/research support —Astra Zeneca, Eli Lilly, Seagen; I.P.: Advisory boards—Prosigna. Speaker bureau/honoraria—Roche; S.S.: Advisory boards—Roche, Novartis, Lilly, Pfizer, BMS, Merck, AstraZeneca, Gilead, Abbvie. Speaker bureau/honoraria—Roche, Novartis, Lilly, Pfizer, BMS, Merck, AstraZeneca, Helsinn, Knight Pharma, Gilead, Viatris, Seagen, Abbvie, Juniper; C.S.; N.B.: Advisory boards—Novartis, AstraZeneca. Speaker bureau/honoraria—Sanofi, Novartis, Lilly, Merck, Knight, Astra Zeneca. Grants/research support—McGill University. Other—Merck, Astra Zeneca, Novartis; D.W.C.: Advisory boards—AstraZeneca, Daiichi Sankyo, Gilead, GlaxoSmithKline, Inflex, Inivata/NeoGenomics, Lilly, Merck, Novartis, Pfizer, Roche and Saga. Grants/research support: AstraZeneca, Guardant Health, Gilead, GlaxoSmithKline, Grail, Inivata/NeoGenomics, Knight, Merck, Pfizer, ProteinQure, Roche, and SAGA; S.C.: Advisory boards—Novartis, Hoffmann LaRoche, Pfizer, Eli Lilly, AstraZeneca, Amgen, Gilead, Merck, Daichi Sanyko. Speaker bureau/honoraria—Novartis, Hoffmann LaRoche, Pfizer, Eli Lilly, AstraZeneca, Amgen, Gilead, Merck, Daichi Sanyko. Grants/research support—Novartis, Hoffmann LaRoche, Pfizer, Genomic Health (Exact Sciences), AstraZeneca, Genentech, Celgene, Amgen, BMS, Merck, Sanofi, PUMA, Gilead; S.E.: Advisory boards—Pfizer, Ipsen, Bayer. Speaker bureau/honoraria—Astellas, Astra Zeneca, Apobiologix, Gilead, Novartis, Pfizer, Ipsen, Eisai, Bayer, Merck. Grants/research support—Astellas, ApoBiologix; J.H.: Advisory boards —BMS, AstraZeneca, Novartis, Lilly, Seattle Genetics, Gilead, GSK, Beigene,. Speaker bureau/honoraria—Gilead. Grants/research support—GSK. A.A.J.: Advisory boards—AstraZeneca, BMS, DS, Gilead, Eli Lilly, Merck, Novartis, Pfizer, Roche; K.L., M.W.: Advisory boards—Genomic Health, Nanostring, Merck, Roche, Purdue, AstraZeneca, BMS, Novartis, Esai, Seattle Genetics, Knight’s Pharmaceuticals, Gilead, Zymeworks; J.-W.H.: Advisory boards—AstraZeneca, Eli Lilly, Gilead Sciences, Novartis, Pfizer, Seagan. Speaker bureau/honoraria—AstraZeneca, Eli Lilly, Gilead Sciences, Novartis, Pfizer, Seagan, University of Toronto. Grants/research support—AstraZeneca, Pfizer, ReThink Breast Cancer, CIHR.

Figures

Figure 1
Figure 1
REAL Alliance recommendations for the treatment of HER2+ early breast cancer. ChT, chemotherapy; cN0, no nodal disease based on clinical assessment; CR, complete response; cT1a/b, tumour ≤ 1 cm on clinical assessment; cT1c, tumours > 1 cm but ≤2 cm on clinical assessment; cT2, tumours > 2 cm but ≤5 cm on clinical assessment; DCH, docetaxel + cyclophosphamide + trastuzumab; H, trastuzumab; HR, hormone receptor; p, based on pathologic assessment; P, pertuzumab; RT, radiotherapy; TCH, docetaxel + carboplatin + trastuzumab.
Figure 2
Figure 2
REAL Alliance recommendations for the treatment of metastatic breast cancer and BM.
See this image and copyright information in PMC

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