An American Society of Clinical Oncology (ASCO) expert panel has reviewed and endorsed guideline recommendations from Cancer Care Ontario (CCO) on the role of patient and disease factors in the selection of adjuvant therapy for women with early-stage breast cancer. The panel’s review and recommendations were published in the Journal of Clinical Oncology.
The CCO’s Early Breast Cancer Systemic Therapy Consensus Panel had developed the recommendations in 2015. A separate guideline has been issued on patient therapies.
Clinicians should consider the following factors when making decisions about adjuvant therapy for women with early-stage breast cancer: lymph node status, tumor size, tumor grade, estrogen receptor (ER) and progesterone receptor (PR) status, human epidermal growth factor receptor 2 (HER2) status, and presence of tumor lymphovascular invasion. Age, menopausal status, and medical comorbidities should also be considered.
The authors have recommended the risk stratification tools Oncotype DX (for hormone receptor–positive, N0 or N1mic or isolated tumor cell, and HER2-negative cancers) and Adjuvant! Online to aid in decision-making.
Adjuvant chemotherapy should be considered for patients with lymph node–positive tumors, ER-negative tumors, HER2-positive tumors, high-risk lymph node–negative tumors (T > 5 mm), and triple-negative tumors, among other characteristics.
Adjuvant chemotherapy may not be of benefit to lymph node–negative tumors without high-risk features or in patients with HER2-negative, strongly ER-positive, and PR-positive breast cancer with positive lymph nodes with micrometastasis, T < 5mm, or an Oncotype DX score with an estimated distant relapse risk of less than 15% at 10 years.
In addition to endorsing the recommendations, Norah Lynn Henry, MD, a medical oncologist at the University of Michigan, and colleagues highlighted areas of the guideline that warrant further consideration, including tumor histology as it relates to adjuvant therapy recommendations, the use of risk stratification tools to guide therapy decisions, and the impact of patient factors on treatment decision-making.
The ASCO panel members believe that patient preference is important in selecting a systemic adjuvant therapy and that estimated life expectancy, functional status, and comorbidities should be considered over age when choosing therapy options for older patients.