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    Asco 2021

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    Alis Poona
    This document provides guidelines from the American Society of Clinical Oncology (ASCO) on the optimal use of neoadjuvant chemotherapy, endocrine therapy, and targeted therapy for breast cancer. It includes recommendations on appropriate candidates for neoadjuvant systemic therapy based on tumor characteristics, how response should be measured, and recommended neoadjuvant regimens for patients with triple negative breast cancer, HR-positive/HER2-negative breast cancer, and HER2-positive disease. The recommendations are based on a systematic review of current medical literature.

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    Asco 2021

    Uploaded by

    Alis Poona
    22 views16 pages
    This document provides guidelines from the American Society of Clinical Oncology (ASCO) on the optimal use of neoadjuvant chemotherapy, endocrine therapy, and targeted therapy for breast cancer. It includes recommendations on appropriate candidates for neoadjuvant systemic therapy based on tumor characteristics, how response should be measured, and recommended neoadjuvant regimens for patients with triple negative breast cancer, HR-positive/HER2-negative breast cancer, and HER2-positive disease. The recommendations are based on a systematic review of current medical literature.

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    ASCO 2021

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    This document provides guidelines from the American Society of Clinical Oncology (ASCO) on the optimal use of neoadjuvant chemotherapy, endocrine therapy, and targeted therapy for breast cancer. It includes recommendations on appropriate candidates for neoadjuvant systemic therapy based on tumor characteristics, how response should be measured, and recommended neoadjuvant regimens for patients with triple negative breast cancer, HR-positive/HER2-negative breast cancer, and HER2-positive disease. The recommendations are based on a systematic review of current medical literature.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    22 views16 pages

    Asco 2021

    Uploaded by

    Alis Poona
    This document provides guidelines from the American Society of Clinical Oncology (ASCO) on the optimal use of neoadjuvant chemotherapy, endocrine therapy, and targeted therapy for breast cancer. It includes recommendations on appropriate candidates for neoadjuvant systemic therapy based on tumor characteristics, how response should be measured, and recommended neoadjuvant regimens for patients with triple negative breast cancer, HR-positive/HER2-negative breast cancer, and HER2-positive disease. The recommendations are based on a systematic review of current medical literature.

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    © All Rights Reserved
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    Download as pdf or txt
    of 16

    Neoadjuvant Chemotherapy, Endocrine

    Therapy, and Targeted Therapy for


    Breast Cancer: ASCO Guideline
    January 28, 2021
    Adjuvant Vs. Neoadjuvant therapy
    • Adjuvant or postoperative systemic therapy is the mainstay of
    treatment for early-stage breast cancer.
    • The goal of adjuvant treatment is to eradicate micro-metastatic
    disease and prevent distant recurrence
    • Neoadjuvant refers to the use of systemic therapy prior to surgery.
    • Indication for neoadjuvant therapy:
    • In-operable disease(Locally advanced)
    • For downsizing/staging
    • For prognosis and post neoadjuvant treatment
    ASCO Guideline
    • Guideline Question: What is the optimal use of neoadjuvant therapy
    for women with invasive, nonmetastatic breast cancer?
    • Target Population: Patients with nonmetastatic breast cancer.
    • Target Audience: Medical oncologists, surgical oncologists,
    radiologists, pathologists, oncology nurses, patients or caregivers or
    advocates, and oncology advanced practice providers.
    • Methods: An Expert Panel was convened to develop clinical practice
    guideline recommendations based on a systematic review of the
    medical literature.
    Benjamin Djulbegovic, MD , Progress in evidence-based medicine: a quarter century on,2017
    Which patients with breast cancer are appropriate
    candidates for neoadjuvant systemic therapy?
    Recommendations: candidates for neoadjuvant
    systemic therapy
    Recommendations Evidence Strength of
    quality recommendation
    1.1 - Patient with inflammatory breast cancer Low Strong
    - Unresectable or locally advanced disease
    1.2 - Tumor histology, grade, stage and estrogen, progesterone, and insufficient moderate
    HER2 expression should routinely be used to guide clinical
    decisions
    insufficient evidence to support the use of other immunochemical
    markers, morphological markers, or genomic profiles
    1.3 - high-risk HER2-positive or triple negative breast cancer (TNBC) → high strong
    residual tumor would guide adjuvant treatment
    1.4 - Reducing the extent of surgery: BCT and  ALND intermediate moderate
    1.5 - a delay in surgery is preferable low moderate
    (eg, for genetic testing ;surgical treatment decision making, to
    allow time to consider reconstructive options)
    How should response be measured in patients
    receiving neoadjuvant chemotherapy?
    Recommendations: Measurement after
    receiving NST
    Recommendations Evidence Strength of
    quality recommendation
    2.1 - Monitored for response with clinical examination insufficient moderate
    - Imaging modality: MMG, US, MRI
    2.2 - Blood- and tissue-based biomarkers should not be used insufficient strong
    for monitoring
    2.3 - Pathologic complete response (pCR), defined as insufficient moderate
    absence of invasive disease in breast and lymph nodes
    → guide clinical making
    What neoadjuvant systemic therapy regimens are
    recommended for patients with TNBC?
    Recommendations: Recommended regimens
    for patients with TNBC
    Recommendations Evidence Strength of
    quality recommendation
    3.1 - clinically node-positive and/or at least T1c disease high strong
    - anthracycline- and taxane-containing regimen
    3.2 - cT1a or cT1bN0 TNBC should not routinely be offered high strong
    neoadjuvant therapy
    3.3 - Carboplatin may be offered for neoadjuvant regimen Intermediate moderate
    →  pCR
    - balance of potential benefits and harms
    3.4 - Insufficient evidence adding the immune checkpoint Intermediate moderate
    inhibitors to neoadjuvant chemotherapy
    What neoadjuvant treatment is recommended for
    patients with HR-positive/HER2-negative breast
    cancer?
    Recommendations: HR-positive/HER2-
    negative breast cancer
    Recommendations Evidence Strength of
    quality recommendation
    4.1 - Neoadjuvant chemotherapy can be used instead of Low moderate
    adjuvant chemotherapy
    - Chemotherapy decision can be made without
    surgical pathology data and/or tumor-specific
    genomic testing
    4.2 - Post menopausal patient: AI →  locoregional Intermediate moderate
    treatment
    - No intent for surgery>> disease control
    4.3 - Pre menopausal patient with early breast cancer: Intermediate moderate
    neoadjuvant endocrine therapy should not be
    routinely offered .
    What neoadjuvant treatment is recommended for
    patients with HER2-positive disease?
    Recommendations: Patients with HER2-
    positive disease
    Recommendations Evidence Strength of
    quality recommendation
    5.1 - Node-positive or high-risk node-negative, HER2- high strong
    positive disease
    - Neoadjuvant therapy with an anthracycline and
    taxane or non–anthracycline-based regimen in
    combination with trastuzumab.
    - Pertuzumab may be used in combination with H.
    5.2 - T1a N0 and T1b N0, HER2-positive disease should not Intermediate moderate
    be routinely offered neoadjuvant chemotherapy or
    anti-HER2 agents

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