Optimal Systemic Therapy for Early Breast Cancer in Women: A Clinical Practice Guideline

Abstract

The Breast Cancer Disease Site Group of Cancer Care Ontario identified the need for new guidelines for the adjuvant systemic therapy of early-stage breast cancer. The specific question to be addressed was “What is the optimal adjuvant systemic therapy for female patients with early-stage operable breast cancer, when patient and disease factors are considered?”A systematic review was prepared based on literature searches conducted using the medline and embase databases for the period January 2008 to March 5, 2012, and updated to May 12, 2014. Guidelines were located from that search, from the Standards and Guidelines Evidence directory of cancer guidelines, and from the Web sites of major guideline organizations. The literature located was subdivided into the broad categories of chemotherapy, hormonal therapy, and therapy targeted to her2 (human epidermal growth factor receptor 2). Although several of the systemic therapies discussed in this guideline can be considered in the neoadjuvant setting, the review focused on trials with rates of disease-free and overall survival as endpoints and thus excluded several trials that used pathologic complete response as a primary endpoint.Based on the systematic review, the working group drafted recommendations on the use of chemotherapy, hormonal therapy, and targeted therapy; based on their professional experience, they also drafted recommendations on patient and disease characteristics and recurrence risk. The literature review and draft recommendations were circulated to a consensus panel of medical oncologists who had expertise in breast cancer and who represented the regions of Ontario. Items without initial consensus were discussed at an in-person consensus meeting held in Toronto, November 23, 2012. The final recommendations are those for which consensus was reached before or at the meeting. Some of the key evidence was revised after the updated literature search. Evidence reviews for systemic chemotherapy, endocrine therapy, and targeted therapy for her2-positive disease are reported in separate articles in this supplement. The full three-part 1-21 evidence-based series, including complete details of the development and consensus processes, can be found on the Cancer Care Ontario Web site at https://www.cancercare.on.ca/toolbox/qualityguidelines/diseasesite/breast-ebs.

Role of Patient and Disease Factors in Adjuvant Systemic Therapy Decision Making for Early-Stage, Operable Breast Cancer: American Society of Clinical Oncology Endorsement of Cancer Care Ontario Guideline Recommendations

“…The target recommendations were developed by members of the Cancer Care Ontario (CCO) Early Breast Cancer Systemic Therapy Consensus Panel in 2015 as part of a comprehensive practice guideline on optimal systemic therapy for early-stage breast cancer in women that was published as an article series in Current Oncology. 1 This ASCO endorsement considers only those recommendations that relate to patient and disease factors, recurrence risk, and selection of patients for adjuvant systemic therapy. A separate ASCO guideline adaptation addresses CCO recommendations on the selection of optimal adjuvant chemotherapy regimens and the selection of adjuvant targeted therapy for HER2-positive cancers.…”

“…Patient characteristics include menopausal status and presence of comorbid conditions; disease characteristics include histopathologic features such as hormone receptor and human epidermal growth factor receptor 2 (HER2) status, tumor grade, lymph node status, and in some cases, gene expression data. 1,2 The American Society of Clinical Oncology (ASCO) Clinical Practice Guidelines Committee identified a set of recommendations for endorsement that addressed the role of these patient and disease factors in selecting adjuvant therapy for women with early-stage breast cancer. The target recommendations were developed by members of the Cancer Care Ontario (CCO) Early Breast Cancer Systemic Therapy Consensus Panel in 2015 as part of a comprehensive practice guideline on optimal systemic therapy for early-stage breast cancer in women that was published as an article series in Current Oncology.…”

Weight gain during adjuvant endocrine treatment for early-stage breast cancer: What is the evidence?

“…For these patients, most of whom will die of non-breast cancer causes, it is recommended that adjuvant therapy include endocrine treatment [26,27]. For women who are postmenopausal at breast cancer diagnosis, it is recommended that adjuvant ET include an aromatase inhibitor (AI) [27,28]-exemestane, anastrozole, or letrozole [29]-unless contraindicated. For women who are premenopausal at breast cancer diagnosis, tamoxifen with or without ovarian suppression (OS) or an AI plus OS are the preferred adjuvant ET [26].…”

Weakly supervised 3D deep learning for breast cancer classification and localization of the lesions in MR images

“…In addition, the MRI scan has also been recommended for screening high‐risk populations . Particularly, dynamic contrast‐enhanced (DCE) MRI can provide accurate information on the location, size, and volume of the lesions, and has become the first‐line method for assessment of tumors …”