Adjuvant endocrine therapy for women with hormone receptor–positive breast cancer: ASCO clinical practice guideline focused update

Harold J. Burstein, Christina Lacchetti, Holly Anderson, Thomas A. Buchholz, Nancy E. Davidson, Karen A. Gelmon, Sharon Hermes Giordano, Clifford A. Hudis, Alexander J. Solky, Vered Stearns, Eric P. Winer, Jennifer J. Griggs

Research output: Contribution to journalArticle

Abstract

PURPOSE To update the ASCO clinical practice guideline on adjuvant endocrine therapy based on emerging data about the optimal duration of aromatase inhibitor (AI) treatment. METHODS ASCO conducted a systematic review of randomized clinical trials from 2012 to 2018. Guideline recommendations were based on the Panel’s review of the evidence from six trials. RESULTS The six included studies of AI treatment beyond 5 years of therapy demonstrated that extension of AI treatment was not associated with an overall survival advantage but was significantly associated with lower risks of breast cancer recurrence and contralateral breast cancer compared with placebo. Bone-related toxic effects were more common with extended AI treatment. RECOMMENDATIONS The Panel recommends that women with node-positive breast cancer receive extended therapy, including an AI, for up to a total of 10 years of adjuvant endocrine treatment. Many women with node-negative breast cancer should consider extended therapy for up to a total of 10 years of adjuvant endocrine treatment based on considerations of recurrence risk using established prognostic factors. The Panel noted that the benefits in absolute risk of reduction were modest and that, for lower-risk node-negative or limited node-positive cancers, an individualized approach to treatment duration that is based on considerations of risk reduction and tolerability was appropriate. A substantial portion of the benefit for extended adjuvant AI therapy was derived from prevention of second breast cancers. Shared decision making between clinicians and patients is appropriate for decisions about extended adjuvant endocrine treatment, including discussions about the absolute benefits in the reduction of breast cancer recurrence, the prevention of second breast cancers, and the impact of adverse effects of treatment. Additional information can be found at www.asco.org/breast-cancer-guidelines.

Original languageEnglish (US)
Pages (from-to)423-438
Number of pages16
JournalJournal of Clinical Oncology
Volume37
Issue number5
DOIs
StatePublished - Feb 10 2019

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Practice Guidelines
Hormones
Breast Neoplasms
Aromatase Inhibitors
Therapeutics
Second Primary Neoplasms
Recurrence
Guidelines
Numbers Needed To Treat
Poisons
Risk Reduction Behavior
Decision Making
Randomized Controlled Trials
Placebos

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Burstein, H. J., Lacchetti, C., Anderson, H., Buchholz, T. A., Davidson, N. E., Gelmon, K. A., ... Griggs, J. J. (2019). Adjuvant endocrine therapy for women with hormone receptor–positive breast cancer: ASCO clinical practice guideline focused update. Journal of Clinical Oncology, 37(5), 423-438. https://doi.org/10.1200/JCO.18.01160

Adjuvant endocrine therapy for women with hormone receptor–positive breast cancer : ASCO clinical practice guideline focused update. / Burstein, Harold J.; Lacchetti, Christina; Anderson, Holly; Buchholz, Thomas A.; Davidson, Nancy E.; Gelmon, Karen A.; Giordano, Sharon Hermes; Hudis, Clifford A.; Solky, Alexander J.; Stearns, Vered; Winer, Eric P.; Griggs, Jennifer J.

In: Journal of Clinical Oncology, Vol. 37, No. 5, 10.02.2019, p. 423-438.

Research output: Contribution to journalArticle

Burstein, HJ, Lacchetti, C, Anderson, H, Buchholz, TA, Davidson, NE, Gelmon, KA, Giordano, SH, Hudis, CA, Solky, AJ, Stearns, V, Winer, EP & Griggs, JJ 2019, 'Adjuvant endocrine therapy for women with hormone receptor–positive breast cancer: ASCO clinical practice guideline focused update' Journal of Clinical Oncology, vol. 37, no. 5, pp. 423-438. https://doi.org/10.1200/JCO.18.01160
Burstein, Harold J. ; Lacchetti, Christina ; Anderson, Holly ; Buchholz, Thomas A. ; Davidson, Nancy E. ; Gelmon, Karen A. ; Giordano, Sharon Hermes ; Hudis, Clifford A. ; Solky, Alexander J. ; Stearns, Vered ; Winer, Eric P. ; Griggs, Jennifer J. / Adjuvant endocrine therapy for women with hormone receptor–positive breast cancer : ASCO clinical practice guideline focused update. In: Journal of Clinical Oncology. 2019 ; Vol. 37, No. 5. pp. 423-438.
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