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ASCO Issues Guidelines for Advanced HER2+ Breast Cancer

Wednesday, May 7, 2014 (Last Updated: 05/08/2014)

WEDNESDAY, May 7, 2014 (HealthDay News) -- The American Society for Clinical Oncology (ASCO) has issued recommendations for the treatment of human epidermal growth factor receptor 2 (HER2)-positive advanced breast cancer and advanced HER2-positive breast cancer with brain metastases. These recommendations were published online May 5 in the Journal of Clinical Oncology.

Sharon H. Giordano, M.D., M.P.H., from University of Texas MD Anderson Cancer Center in Houston, and colleagues conducted a systematic literature review of 16 trials to provide evidence-based recommendations relating to systemic therapy for HER2-positive advanced breast cancer. The authors recommend HER2-targeted therapy for most patients. First-line treatment should include trastuzumab, pertuzumab, and taxane, while trastuzumab emtansine (T-DM1) is recommended as second-line treatment. Other HER2-targeted therapy combinations or T-DM1 should be offered as third-line therapy, as well as pertuzumab if not previously offered. The optimal chemotherapy duration is four to six months or more, or until maximum response.

In a second guideline, Naren Ramakrishna, M.D., from the Mayo Clinic in Jacksonville, Fla., and colleagues conducted a formal expert consensus-based process to develop recommendations for the management of brain metastases for patients with HER2-positive advanced breast cancer. The authors note that patients with brain metastases should receive local and systemic therapy, with local therapy options including surgery, whole-brain radiotherapy, and stereotactic radiosurgery. Systemic therapy, best supportive care, enrollment onto a clinical trial and/or palliative care are also treatment options.

"ASCO believes that cancer clinical trials are vital to inform medical decisions and improve cancer care and that all patients should have the opportunity to participate," Ramakrishna and colleagues write.

Several authors from both studies disclosed financial ties to the pharmaceutical industry.

Abstract - Giordano
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Abstract - Ramakrishna
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