Systemic Treatment of Patients With Metastatic Breast Cancer: ASCO Resource-Stratified Guideline

• Published in: JCO global oncology Vol. 10; no. 10; p. e2300285
• Main Authors: Al Sukhun, Sana, Temin, Sarah, Barrios, Carlos H, Antone, Nicoleta Zenovia, Guerra, Yanin Chavarri, Mac Gregor, Mariana Chavez, Chopra, Rakesh, Danso, Michael A, Gomez, Henry Leonidas, Homian, N'Da Marcelin, Kandil, Alaa, Kithaka, Benda, Koczwara, Bogda, Moy, Beverly, Nakigudde, Gertrude, Petracci, Fernando Enrique, Rugo, Hope S, El Saghir, Nagi S, Arun, Banu K
• Format: Journal Article
• Language: English
• Published: United States Wolters Kluwer Health 01.01.2024; American Society of Clinical Oncology
• Subjects: SPECIAL ARTICLES
• ISSN: 2687-8941; 2687-8941
• DOI: 10.1200/GO.23.00285

To guide clinicians and policymakers in three global resource-constrained settings on treating patients with metastatic breast cancer (MBC) when Maximal setting-guideline recommended treatment is unavailable. A multidisciplinary, multinational panel reviewed existing ASCO guidelines and conducted modified ADAPTE and formal consensus processes. Four published resource-agnostic guidelines were adapted for resource-constrained settings; informing two rounds of formal consensus; recommendations received ≥75% agreement. Clinicians should recommend treatment according to menopausal status, pathological and biomarker features when quality results are available. In first-line, for hormone receptor (HR)-positive MBC, when a non-steroidal aromatase inhibitor and CDK 4/6 inhibitor combination is unavailable, use hormonal therapy alone. For life-threatening disease, use single-agent chemotherapy or surgery for local control. For premenopausal patients, use ovarian suppression or ablation plus hormone therapy in Basic settings. For human epidermal growth factor receptor 2 (HER2)-positive MBC, if trastuzumab, pertuzumab, and chemotherapy are unavailable, use trastuzumab and chemotherapy; if unavailable, use chemotherapy. For HER2-positive, HR-positive MBC, use standard first-line therapy, or endocrine therapy if contraindications. For triple-negative MBC with unknown PD-L1 status, or if PD-L1-positive and immunotherapy unavailable, use single-agent chemotherapy. For germline / mutation-positive MBC, if poly(ADP-ribose) polymerase inhibitor is unavailable, use hormonal therapy (HR-positive MBC) and chemotherapy (HR-negative MBC). In second-line, for HR-positive MBC, Enhanced setting recommendations depend on prior treatment; for Limited, use tamoxifen or chemotherapy. For HER2-positive MBC, if trastuzumab deruxtecan is unavailable, use trastuzumab emtansine; if unavailable, capecitabine and lapatinib; if unavailable, trastuzumab and/or chemotherapy (hormonal therapy alone for HR-positive MBC).Additional information is available at www.asco.org/resource-stratified-guidelines. It is ASCO's view that healthcare providers and system decision-makers should be guided by the recommendations for the highest stratum of resources available. The guideline is intended to complement but not replace local guidelines.