Use of Biomarkers to Guide Decisions on Systemic Therapy for Women With Metastatic Breast Cancer: American Society of Clinical Oncology Clinical Practice Guideline
Use of Biomarkers to Guide Decisions on Systemic Therapy for Women With Metastatic Breast Cancer: American Society of Clinical Oncology Clinical Practice Guideline
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DOI：
10.1200/jco.2015.61.1459
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发表时间：
2015-08-20
影响因子：
45.3
通讯作者：
Harris, Lyndsay N.
中科院分区：
文献类型：
--
作者：
Van Poznak, Catherine;Somerfield, Mark R.;Harris, Lyndsay N.
目的为适当使用乳腺肿瘤生物标志物检测结果提供建议，以指导转移性乳腺癌的全身治疗决策。方法文献检索和前瞻性定义的研究选择确定了 2006 年至 2014 年 9 月发表的系统评价、荟萃分析、随机对照试验 (RCT)、前瞻性回顾性研究和前瞻性比较观察研究。结果文献检索显示 17 符合进一步审查标准的文章：11 项研究报告了原发肿瘤和转移瘤在激素受体或人表皮生长因子受体 2 (HER2) 表达方面的不一致，一项随机对照试验探讨了使用生物标志物来决定是否改变或继续治疗方案，以及五项评估生物标志物临床实用性的前瞻性回顾性研究。 应进行活检以确认疾病过程，并重新检测雌激素受体、孕激素受体和 HER2 状态，但缺乏证据来确定根据受体状态变化而改变抗癌治疗是否会影响临床结果。由于原发组织和转移组织之间的结果不一致，专家组一致认为，如果临床情况和患者的护理目标支持，则优先使用转移灶的雌激素受体、孕激素受体和 HER2 状态来指导治疗。癌胚抗原、癌抗原15-3和癌抗原27-29可以用作辅助评估，但不能单独使用，以有助于治疗决策。在缺乏旨在评估标记物临床实用性的研究的情况下，肿瘤再活检和使用循环肿瘤标记物的建议是基于临床经验和专家组非正式共识。因此，临床医生不使用这些标志物作为辅助评估也是合理的。 (C) 2015 年美国临床肿瘤学会
PurposeTo provide recommendations on the appropriate use of breast tumor biomarker assay results to guide decisions on systemic therapy for metastatic breast cancer.MethodsA literature search and prospectively defined study selection identified systematic reviews, meta-analyses, randomized controlled trials (RCTs), prospective-retrospective studies, and prospective comparative observational studies published from 2006 through September 2014.ResultsThe literature search revealed 17 articles that met criteria for further review: 11 studies reporting discordances between primary tumors and metastases in expression of hormone receptors or human epidermal growth factor receptor 2 (HER2), one RCT that addressed the use of a biomarker to decide whether to change or continue a treatment regimen, and five prospective-retrospective studies that evaluated the clinical utility of biomarkers.RecommendationsIn patients with accessible metastases, biopsy for confirmation of disease process and retesting of estrogen receptor, progesterone receptor, and HER2 status should be offered, but evidence is lacking to determine whether changing anticancer treatment on the basis of change in receptor status affects clinical outcomes. With discordance of results between primary and metastatic tissues, the Panel consensus is to use preferentially the estrogen receptor, progesterone receptor, and HER2 status of the metastasis to direct therapy if supported by the clinical scenario and patient's goals for care. Carcinoembryonic antigen, cancer antigen 15-3, and cancer antigen 27-29 may be used as adjunctive assessments, but not alone, to contribute to decisions regarding therapy. Recommendations for tumor rebiopsy and use of circulating tumor markers are based on clinical experience and Panel informal consensus in the absence of studies designed to evaluate the clinical utility of the markers. As such, it is also reasonable for clinicians to not use these markers as adjunctive assessments. (C) 2015 by American Society of Clinical Oncology