Systemic Treatment of Patients With Metastatic Breast Cancer: ASCO Resource-Stratified Guideline

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. A multidisciplinary, multinational panel reviewed existing ASCO guidelines and conducted mo...

Full description

Saved in:

Bibliographic Details
Published in:	JCO global oncology 2024-01, Vol.10 (10), p.e2300285-e2300285
Main Authors:	Al Sukhun, Sana, Temin, Sarah, Barrios, Carlos H, Antone, Nicoleta Zenovia, Guerra, Yanin Chavarri, Chavez-MacGregor, Mariana, Chopra, Rakesh, Danso, Michael A, Gomez, Henry Leonidas, Homian, N'Da Marcelin, Kandil, Alaa, Kithaka, Benda, Koczwara, Bogda, Moy, Beverly, Nakigudde, Gertrude, Petracci, Fernando Enrique, Rugo, Hope S, El Saghir, Nagi S, Arun, Banu K
Format:	Article
Language:	eng
Subjects:	B7-H1 Antigen BRCA1 Protein BRCA2 Protein Hormones Humans SPECIAL ARTICLES Trastuzumab - therapeutic use Triple Negative Breast Neoplasms
Online Access:	Get full text
Tags:	Add Tag No Tags, Be the first to tag this record!

Description
Summary:	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. A multidisciplinary, multinational panel reviewed existing ASCO guidelines and conducted modified ADAPTE and formal consensus processes. Four published resource-agnostic guidelines were adapted for resource-constrained settings; informing two rounds of formal consensus; recommendations received ≥75% agreement. 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 / 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 www.asco.org/resource-stratified-guidelines. 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.
ISSN:	2687-8941 2687-8941