Chemotherapy and Targeted Therapy for Women With Human Epidermal Growth Factor Receptor 2-Negative (or unknown) Advanced Breast Cancer: American Society of Clinical Oncology Clinical Practice Guideline
Chemotherapy and Targeted Therapy for Women With Human Epidermal Growth Factor Receptor 2-Negative (or unknown) Advanced Breast Cancer: American Society of Clinical Oncology Clinical Practice Guideline
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DOI：
10.1200/jco.2014.56.7479
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发表时间：
2014-10-10
影响因子：
45.3
通讯作者：
Smith, Ian E.
中科院分区：
文献类型：
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作者：
Partridge, Ann H.;Rumble, R. Bryan;Smith, Ian E.
目的探讨人表皮生长因子2 （HER2）阴性（或未知）晚期乳腺癌的最佳化疗和靶向治疗方法。方法对1993年至今的随机证据进行系统评价（包括系统评价和荟萃分析）。关注的结局包括生存、无进展生存、反应、生活质量和不良反应。指南建议以证据为基础，经专家小组协商一致通过。结果79项研究符合纳入标准，包括20项系统评价和/或荟萃分析，30项一线治疗试验，29项二线及后续治疗试验。这些试验构成了指南建议的证据基础。推荐雌激素受体阳性转移性乳腺癌患者，除非医学上有必要改善（例如，立即危及生命的疾病），否则内分泌治疗优于化疗作为一线治疗。单药优于联合化疗，较长的计划持续时间可以改善结果，但必须平衡毒性。没有单一的最佳一线或后续化疗方案，治疗的选择将由多种因素决定，包括既往治疗、毒性、表现状况、合并症和患者偏好。贝伐单抗的作用仍有争议。到目前为止，其他靶向治疗尚未被证明能提高her2阴性乳腺癌的化疗结果。(C) 2014年由美国临床肿瘤学会出版
PurposeTo identify optimal chemo-and targeted therapy for women with human epidermal growth factor 2 (HER2)-negative (or unknown) advanced breast cancer.MethodsA systematic review of randomized evidence (including systematic reviews and meta-analyses) from 1993 through to current was completed. Outcomes of interest included survival, progressionfree survival, response, quality of life, and adverse effects. Guideline recommendations were evidence based and were agreed on by the Expert Panel via consensus.ResultsSeventy-nine studies met the inclusion criteria, comprising 20 systematic reviews and/or metaanalyses, 30 trials on first-line treatment, and 29 trials on second-line and subsequent treatment. These trials form the evidence base for the guideline recommendations.RecommendationsEndocrine therapy is preferable to chemotherapy as first-line treatment for patients with estrogen receptor-positive metastatic breast cancer unless improvement is medically necessary (eg, immediately life-threatening disease). Single agent is preferable to combination chemotherapy, and longer planned duration improves outcome but must be balanced against toxicity. There is no single optimal first-line or subsequent line chemotherapy, and choice of treatment will be determined by multiple factors including prior therapy, toxicity, performance status, comorbid conditions, and patient preference. The role of bevacizumab remains controversial. Other targeted therapies have not so far been shown to enhance chemotherapy outcome in HER2-negative breast cancer. (C) 2014 by American Society of Clinical Oncology