Systemic Therapy for Patients With Advanced Human Epidermal Growth Factor Receptor 2-Positive Breast Cancer: American Society of Clinical Oncology Clinical Practice Guideline
Systemic Therapy for Patients With Advanced Human Epidermal Growth Factor Receptor 2-Positive Breast Cancer: American Society of Clinical Oncology Clinical Practice Guideline
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DOI：
10.1200/jco.2013.54.0948
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发表时间：
2014-07-01
影响因子：
45.3
通讯作者：
Winer, Eric P.
中科院分区：
文献类型：
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作者：
Giordano, Sharon H.;Temin, Sarah;Winer, Eric P.
目的：为临床肿瘤学家和其他人提供基于证据的关于人表皮生长因子受体2 （HER2）阳性晚期乳腺癌患者全身治疗的建议。方法2009年1月至2012年10月，美国临床肿瘤学会召集内科肿瘤学、放射肿瘤学、指南实施和倡导专家小组，进行系统文献综述。研究结果包括总生存期、无进展生存期（PFS）和不良事件。结果16项试验符合系统评价标准。CLEOPATRA试验发现多西他赛、曲妥珠单抗和帕妥珠单抗在一线治疗中有生存和PFS益处，EMILIA试验发现曲妥珠单抗emtansine （T-DM1）在二线治疗中有生存和PFS益处。T-DM1也显示出三线PFS益处。一项试验报告了her2靶向治疗的持续时间，另外三项试验报告了her阳性晚期乳腺癌患者的内分泌治疗。推荐her2阳性晚期乳腺癌患者接受her2靶向治疗，但临床充血性心力衰竭或左心室射血分数明显降低的患者除外，这些患者应根据具体情况进行评估。推荐曲妥珠单抗、帕妥珠单抗和紫杉烷用于一线治疗，T-DM1用于二线治疗。在三线治疗中，临床医生应该提供其他her2靶向治疗组合或T-DM1（如果以前没有给药），如果患者以前没有接受过帕妥珠单抗，也可以提供帕妥珠单抗。化疗的最佳持续时间至少为4至6个月或直到最大反应，这取决于毒性和无进展。her2靶向治疗可以继续，直到出现进展或不可接受的毒性。对于her2阳性和雌激素受体阳性/孕激素受体阳性的乳腺癌患者，临床医生可能会推荐标准的一线治疗，或者对于选定的患者，内分泌治疗加her2靶向治疗或单独内分泌治疗。(c) 2014年由美国临床肿瘤学会发布
Purpose To provide evidence-based recommendations to practicing oncologists and others on systemic therapy for patients with human epidermal growth factor receptor 2 (HER2) -positive advanced breast cancer.Methods The American Society of Clinical Oncology convened a panel of medical oncology, radiation oncology, guideline implementation, and advocacy experts and conducted a systematic literature review from January 2009 to October 2012. Outcomes of interest included overall survival, progression-free survival (PFS), and adverse events.Results A total of 16 trials met the systematic review criteria. The CLEOPATRA trial found survival and PFS benefits for docetaxel, trastuzumab, and pertuzumab in first-line treatment, and the EMILIA trial found survival and PFS benefits for trastuzumab emtansine (T-DM1) in second-line treatment. T-DM1 also showed a third-line PFS benefit. One trial reported on duration of HER2-targeted therapy, and three others reported on endocrine therapy for patients with HER-positive advanced breast cancer.Recommendations HER2-targeted therapy is recommended for patients with HER2-positive advanced breast cancer, except for those with clinical congestive heart failure or significantly compromised left ventricular ejection fraction, who should be evaluated on a case-by-case basis. Trastuzumab, pertuzumab, and taxane for first-line treatment and T-DM1 for second-line treatment are recommended. In the third-line setting, clinicians should offer other HER2-targeted therapy combinations or T-DM1 (if not previously administered) and may offer pertuzumab, if the patient has not previously received it. Optimal duration of chemotherapy is at least 4 to 6 months or until maximum response, depending on toxicity and in the absence of progression. HER2-targeted therapy can continue until time of progression or unacceptable toxicities. For patients with HER2-positive and estrogen receptor-positive/progesterone receptor-positive breast cancer, clinicians may recommend either standard first-line therapy or, for selected patients, endocrine therapy plus HER2-targeted therapy or endocrine therapy alone. (c) 2014 by American Society of Clinical Oncology