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J Clin Oncol. 2018 Sep 10;36(26):2736-2740. doi: 10.1200/JCO.2018.79.2697. Epub 2018 Jun 25.

Systemic Therapy for Patients With Advanced Human Epidermal Growth Factor Receptor 2-Positive Breast Cancer: ASCO Clinical Practice Guideline Update.

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Sharon H. Giordano, The University of Texas MD Anderson, Houston; Debra A. Patt, Texas Oncology, Austin, TX; Sarah Temin, American Society of Clinical Oncology, Alexandria, VA; Sarat Chandarlapaty and Shanu Modi, Memorial Sloan Kettering Cancer Center; Francisco J. Esteva, New York University Langone Medical Center, New York; Jeffrey J. Kirshner, Hematology/Oncology Associates of Central New York, East Syracuse, NY; Jennie R. Crews, Seattle Cancer Care Alliance; Nancy E. Davidson, Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA; Ian E. Krop, Nancy U. Lin, and Eric P. Winer, Dana-Farber Cancer Institute, Boston, MA; Jennifer Levinson, Ponte Vedra Beach; Naren Ramakrishna, Orlando Health University of Florida Health Cancer Center, Orlando, FL; and Jane Perlmutter, Ann Arbor, MI.


Purpose To update evidence-based guideline recommendations for practicing oncologists and others on systemic therapy for patients with human epidermal growth factor receptor 2 (HER2)-positive advanced breast cancer to 2018. Methods An Expert Panel conducted a targeted systematic literature review (for both systemic treatment and CNS metastases) and identified 622 articles. Outcomes of interest included overall survival, progression-free survival, and adverse events. Results Of the 622 publications identified and reviewed, no additional evidence was identified that would warrant a change to the 2014 recommendations. 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 trastuzumab emtansine for second-line treatment are recommended. In the third-line setting, clinicians should offer other HER2-targeted therapy combinations or trastuzumab emtansine (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. Additional information is available at .

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