Introduction

Treatment

Design and created by Guideline Central in participation with the American Society of Clinical Oncology.

Metastatic HER2-Negative Breast Cancer – Chemo- and Targeted Therapy

American Society of Clinical Oncology

Publication Date: January 10, 2023

Table 1. Targeted Therapies for Metastatic (or locally advanced) Breast Cancer

Company Product Generic Name	Type	Indications	Dose
pembrolizumab	Immune Checkpoint Inhibitor	Triple-negative breast cancer expressing PD-L1	200 mg every 3 weeks or 400 mg every 6 weeks with chemotherapy
sacituzumab govitecan	Trop-2-directed antibody and topoisomerase inhibitor conjugate	3rd line for triple-negative breast cancer	10 mg/kg IV once weekly on Days 1 and 8 of continuous 21-day treatment
olaparib	PARP Inhibitor	2nd line for HER2-negative metastatic breast cancer	300 mg taken orally twice daily
talazoparib	PARP Inhibitor	Deleterious or suspected deleterious germline BRCA-mutated ( gBRCAm) HER2-negative breast cancer	1 mg taken orally once daily
eribulin mesylate	Microtubule inhibitor for single agent chemotherapy	3rd line for metastatic breast cancer	1.4 mg/m² IV over 2–5 minutes on Days 1 and 8 of a 21 day cycle
ixabepilone	Microtubule inhibitor for single agent chemotherapy or with capecitabine	2nd line for the treatment of metastatic or locally advanced breast cancer	40 mg/m² IV over 3 hours every 3 weeks

Grading Table

Type		Benefit/harm		Evidence Quality		Strength of Recommendation
EB	Evidence-based	B	Benefits outweigh harms	H	High	Strong
CB	Consensus-based	H	Harms outweigh benefits	I	Intermediate	Moderate
IC	Informal consensus	B/H	Relative balance of benefits and harms	L	Low	Weak
IC	Informal consensus	U	Unknown	Ins	Insufficient	Weak

Abbreviations

BRCA: BReast CAncer gene

BRCA1: BReast CAncer gene 1

BRCA2: BReast CAncer gene 2

HER2: Human Epidermal Growth Factor Receptor 2

HR: hormone receptor

OS: overall survival

parp: poly (ADP -ribose) polymerase

Source Citation

Moy B, Rumble RB, Come S et al. 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 Rapid Recommendation Update. J Clin Oncol. 2023 January 10. doi: 10.1200/JCO.22.02807

Moy B, Rumble RB, Come S et al. 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 Rapid Recommendation Update. J Clin Oncol. 2022 August 4. doi: 10.1200/JCO.22.01533

Moy B, Rumble RB, Come S et al. 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. J Clin Oncol. 2021;39(35):3938-3958. doi:10.1200/jco.21.01374.

Disclaimer

This pocket guide is derived from recommendations in the American Society of Clinical Oncology Guideline. This resource is a practice tool based on ASCO® practice guidelines and is not intended to substitute for the independent professional judgment of the treating physician. Practice guidelines do not account for individual variation among patients. This pocket guide does not purport to suggest any particular course of medical treatment. Use of the practice guidelines and this resource are voluntary. The practice guidelines and additional information are available at www.asco.org/breast-cancer-guidelines. Copyright © 2023 by American Society of Clinical Oncology. All rights reserved.

Metastatic HER2-Negative Breast Cancer – Chemo- and Targeted Therapy

Introduction

Treatment

New Recommendation from 2023 Guideline Rapid Recommendation Update

New Recommendation from 2022 Guideline Rapid Recommendation Update

Table 1. Targeted Therapies for Metastatic (or locally advanced) Breast Cancer

Figure 1. Management of Metastatic HR-positive Breast Cancer

Figure 2. Management of Metastatic Triple Negative Breast Cancer

Grading Table

Abbreviations

Source Citation

Disclaimer