美国乳腺癌化疗和靶向治疗指南更新
2014年，美国临床肿瘤学会首次发表HER2阴性（或未知）晚期乳腺癌女性化疗和靶向治疗临床实践指南。7年以来，随着BOLERO-6、PEARL、ASCENT、TNT、CALGB 40502、NCCTG N063H、EMBRACE、IMpassion 130、KEYNOTE-355、OlympiAD、EMBRACA等研究结果相继公布，美国临床肿瘤学会将该指南扩展至激素受体阴性或内分泌治疗后HER2阴性晚期乳腺癌化疗和靶向治疗。
2021年7月29日，美国临床肿瘤学会《临床肿瘤学杂志》在线发表哈佛大学麻省总医院、美国临床肿瘤学会、贝斯以色列和新英格兰女执事医疗中心、西雅图华盛顿大学、弗雷德哈钦森癌症研究中心、西雅图癌症治疗中心、德克萨斯大学MD安德森癌症中心、明尼苏达大学、芝加哥大学、西达赛奈医疗中心、北卡罗来纳大学莱恩伯格综合癌症中心、梅奥医学中心、佛蒙特大学医疗中心、圣弗朗西斯医疗中心、南佛罗里达大学莫菲特癌症中心、弗吉尼亚肿瘤医院、田纳西肿瘤医院、纽约患者代表、达拉斯患者代表、意大利普拉托医院、托斯卡纳肿瘤研究所、英国皇家马斯登医院联合更新的激素受体阴性或内分泌治疗后HER2阴性晚期乳腺癌化疗和靶向治疗指南。
指南专家组对2014年以来新发表的文献进行系统回顾，以确定可能改变临床实践并转化为修订指南推荐意见的新数据。
结果，14篇文献符合入选标准并构成该指南的推荐意见证据基础。
该指南主要推荐意见更新如下：
对于免疫细胞程序性死亡配体PD-L1阳性的晚期三阴性乳腺癌患者，可将免疫检查点抑制剂（阿替利珠单抗或帕博利珠单抗）加入化疗（白蛋白紫杉醇、紫杉醇或吉西他滨＋卡铂）作为一线治疗（类型：循证；利大于弊；证据质量：中；推荐强度：强）
对于免疫细胞程序性死亡配体PD-L1阴性的晚期三阴性乳腺癌患者，应提供单药化疗而非将联合化疗作为一线治疗，虽然联合方案可用于症状严重或威胁生命的疾病（类型：循证；利大于弊；证据质量：中；推荐强度：强）
对于乳腺癌转移后接受过至少两线治疗的晚期三阴性乳腺癌患者，应提供戈沙妥珠单抗治疗（类型：循证；利大于弊；证据质量：高；推荐强度：强）
对于既往接受过化疗的种系BRCA突变晚期三阴性乳腺癌患者，可提供多腺苷二磷酸核糖聚合酶PARP抑制剂（奥拉帕利或他拉唑帕利）而非化疗（类型：循证；利大于弊；证据质量：中；推荐强度：强）
对于考虑化疗的激素受体阳性HER2阴性晚期乳腺癌患者，应提供单药化疗而非联合化疗，虽然联合方案可用于症状严重或威胁生命的疾病（类型：循证；利大于弊；证据质量：中；推荐强度：强）
对于内分泌药物治疗期间疾病进展的激素受体阳性晚期乳腺癌患者，可提供内分泌治疗±靶向治疗或单药化疗（类型：循证；利大于弊；证据质量：中；推荐强度：强）
对于种系BRCA突变的激素受体阳性晚期乳腺癌患者，内分泌治疗难以获益，可以提供PARP抑制剂而非化疗（类型：循证；利大于弊；证据质量：中；推荐强度：强）
关于应何时过渡至临终关怀或姑息治疗，目前缺乏推荐意见（类型：共识；利弊未知；证据质量：无；推荐强度：强）
相关链接
J Clin Oncol. 2021 Jul 29. Online ahead of print.
Chemotherapy and Targeted Therapy for Patients With Human Epidermal Growth Factor Receptor 2-Negative Metastatic Breast Cancer That is Either Endocrine-Pretreated or Hormone Receptor-Negative: ASCO Guideline Update.
Moy B, Rumble RB, Come SE, Davidson NE, Di Leo A, Gralow JR, Hortobagyi GN, Yee D, Smith IE, Chavez-MacGregor M, Nanda R, McArthur HL, Spring L, Reeder-Hayes KE, Ruddy KJ, Unger PS, Vinayak S, Irvin WJ Jr, Armaghani A, Danso MA, Dickson N, Turner SS, Perkins CL, Carey LA.
Massachusetts General Hospital, Boston, MA; American Society of Clinical Oncology, Alexandria, VA; Beth Israel Deaconess Medical Center, Boston, MA; Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA; Hospital of Prato, Istituto Toscano Tumori, Prato, Italy; University of Washington, Seattle, WA; MD Anderson Cancer Center, Houston, TX; University of Minnesota, Minneapolis and Saint Paul, MN; Royal Marsden Hospital, London, United Kingdom; University of Chicago, Chicago, IL; Cedars-Sinai, Los Angeles, CA; UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC; Mayo Clinic, Rochester, MN; University of Vermont Health Network, Burlington, VT; Seattle Cancer Care Alliance and University of Washington, Seattle, WA; Bon Secours St Francis, Midlothian, VA; Moffitt Cancer Center, Tampa, FL; Virginia Oncology Associates, Norfolk, VA; Tennessee Oncology, Nashville, TN; Patient Representative, New York, NY; Patient Representative, Dallas, TX.
PURPOSE: This guideline updates recommendations of the ASCO guideline on chemotherapy and targeted therapy for patients with human epidermal growth factor receptor 2-negative metastatic breast cancer (MBC) that is either endocrine-pretreated or hormone receptor (HR)-negative.
METHODS: An Expert Panel conducted a targeted systematic literature review guided by a signals approach to identify new, potentially practice-changing data that might translate into revised guideline recommendations.
RESULTS: The Expert Panel reviewed abstracts from the literature review and retained 14 articles.
RECOMMENDATIONS: Patients with triple-negative, programmed cell death ligand-1-positive MBC may be offered the addition of immune checkpoint inhibitor to chemotherapy as first-line therapy. Patients with triple-negative, programmed cell death ligand-1-negative MBC should be offered single-agent chemotherapy rather than combination chemotherapy as first-line treatment, although combination regimens may be offered for life-threatening disease. Patients with triple-negative MBC who have received at least two prior therapies for MBC should be offered treatment with sacituzumab govitecan. Patients with triple-negative MBC with germline BRCA mutations previously treated with chemotherapy may be offered a poly (ADP-ribose) polymerase inhibitor rather than chemotherapy. Patients with HR-positive human epidermal growth factor receptor 2-negative MBC for whom chemotherapy is being considered should be offered single-agent chemotherapy rather than combination chemotherapy, although combination regimens may be offered for highly symptomatic or life-threatening disease. Patients with HR-positive MBC with disease progression on an endocrine agent may be offered treatment with either endocrine therapy with or without targeted therapy or single-agent chemotherapy. Patients with HR-positive MBC with germline BRCA mutations no longer benefiting from endocrine therapy may be offered a poly (ADP-ribose) polymerase inhibitor rather than chemotherapy. No recommendation regarding when a patient's care should be transitioned to hospice or best supportive care alone is possible.
PMID: 34324366
DOI: 10.1200/JCO.21.01374