ASCO Guideline Update: Adjuvant Chemotherapy and Targeted Therapy for Breast Cancer
Posted: Monday, September 10, 2018
The American Society of Clinical Oncology (ASCO) provided updates to its guidelines on adjuvant chemotherapy and targeted therapy for breast cancer. An expert panel, co-chaired by Neelima Denduluri, MD, of US Oncology Network, Virginia Cancer Specialists, and Sharon H. Giordano, MD, of The University of Texas MD Anderson Cancer Center, published its recommendations in the Journal of Clinical Oncology.
“For this focused update, three phase III, randomized, adjuvant trials addressing capecitabine, pertuzumab, and neratinib provided the signals,” stated the researchers.
Three questions were reviewed for the focused update:
- Should capecitabine be administered after standard preoperative anthracycline and taxane-based combination chemotherapy in patients with early-stage, HER2-negative breast cancer?
- Should pertuzumab follow trastuzumab-based combination chemotherapy in patients with early-stage, HER2-positive breast cancer?
- Should neratinib follow combination chemotherapy and trastuzumab-based adjuvant therapy in patients with early-stage, HER2-positive breast cancer?
Capecitabine is now recommended for up to six to eight cycles as an adjuvant therapy for patients with early-stage HER2-negative breast cancer with pathologic, invasive residual disease at surgery after anthracycline and taxane-based preoperative treatment. For patients with HER2-positive breast cancer, pertuzumab and neratinib can be considered in different settings. In high-risk, early-stage patients, pertuzumab may be used up to 1 year after trastuzumab-based combination chemotherapy. As an extended adjuvant therapy, neratinib can be used; however, diarrhea prophylaxis should accompany its administration.
Aside from these three changes, the established 2016 ASCO guidelines remain unchanged.