Role of Patient and Disease Factors in Adjuvant Systemic Therapy Decision Making for Early-Stage, Operable Breast Cancer: Update of the ASCO Endorsement of the Cancer Care Ontario Guideline
| Autor: | Mark R. Somerfield, Andrea Eisen, Diana T. Chingos, Kimberly H. Allison, Praveen Vikas, N. Lynn Henry, Thomas H. Openshaw, Nofisat Ismaila, Carey K. Anders, Patricia A. Spears, Bruno Lemos Ferrari, Vered Stearns, Vandana G. Abramson |
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| Rok vydání: | 2019 |
| Předmět: |
Adult
Cancer Research medicine.medical_specialty Decision Making MEDLINE Breast Neoplasms Medical Oncology Systemic therapy 03 medical and health sciences 0302 clinical medicine Breast cancer medicine Humans Combined Modality Therapy Prospective Studies 030212 general & internal medicine Stage (cooking) Prospective cohort study Intensive care medicine Oligonucleotide Array Sequence Analysis Ontario Clinical Trials as Topic business.industry Gene Expression Profiling Cancer Guideline Middle Aged Decision Support Systems Clinical medicine.disease Treatment Outcome Oncology Chemotherapy Adjuvant 030220 oncology & carcinogenesis Practice Guidelines as Topic Female Lymph Nodes Neoplasm Recurrence Local business |
| Zdroj: | Journal of Clinical Oncology. 37:1965-1977 |
| ISSN: | 1527-7755 0732-183X |
| DOI: | 10.1200/jco.19.00948 |
| Popis: | PURPOSE To update the American Society of Clinical Oncology endorsement of the Cancer Care Ontario recommendations on the Role of Patient and Disease Factors in Adjuvant Systemic Therapy Decision Making for Early-Stage, Operable Breast Cancer. METHODS Two phase III trials—the Trial Assigning Individualized Options for Treatment (TAILORx) in women with hormone receptor–positive, node-negative tumors and the Microarray in Node-Negative and 1 to 3 Positive Lymph Node Disease May Avoid Chemotherapy (MINDACT) trial—provided the evidence for this update. UPDATED RECOMMENDATIONS Shared decision making between clinicians and patients is appropriate for adjuvant systemic therapy for breast cancer. For patients older than age 50 years and whose tumors have Onco type DX recurrence scores less than 26, and for patients age 50 years or younger whose tumors have Onco type DX recurrence scores less than 16, there is little to no benefit from chemotherapy. Clinicians may offer endocrine therapy alone for these patients. For patients age 50 years or younger with recurrence scores of 16 to 25, clinicians may offer chemoendocrine therapy. Patients with recurrence scores greater than 30 should be considered candidates for chemoendocrine therapy. Based on informal consensus, the Panel recommends that oncologists may offer chemoendocrine therapy to patients with Onco type DX scores of 26 to 30. The MammaPrint assay could be used to guide decisions on withholding adjuvant systemic chemotherapy in patients with hormone receptor–positive lymph node–negative breast cancer and in select patients with lymph node–positive cancers. In both patients with node-positive and node-negative disease, evidence of clinical utility of the MammaPrint assay was only apparent in those determined to be at high clinical risk; the Panel thus did not recommend use of MammaPrint assay in patients determined to be at low clinical risk. Remaining recommendations from the 2016 ASCO guideline endorsement are unchanged. Additional information is available at www.asco.org/breast-cancer-guidelines . |
| Databáze: | OpenAIRE |
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