Key Points

Treatment

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

Advanced Human Epidermal Growth Factor Receptor 2-Positive Breast Cancer

American Society of Clinical Oncology

Publication Date: May 31, 2022

Grading Table

Recommendation Grading

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

Recommendation Rating Definitions

Quality of Evidence

Term	Definitions
H = High	We are very confident that the true effect lies close to that of the estimate of the effect
M = Moderate	We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different.
L = Low	Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect.
VL = Very low	We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect.

Strength of Recommendation

Term	Definitions
S = Strong	In recommendations for an intervention, the desirable effects of an intervention outweigh its undesirable effects. In recommendations against an intervention, the undesirable effects of an intervention outweigh its desirable effects. All or almost all informed people would make the recommended choice for or against an intervention.
C = Conditional/ W = Weak	In recommendations for an intervention, the desirable effects probably outweigh the undesirable effects, but appreciable uncertainty exists. In recommendations against an intervention, the undesirable effects probably outweigh the desirable effects, but appreciable uncertainty exists. Most informed people would choose the recommended course of action, but a substantial number would not.

Brozek JL, Akl EA, Compalati E, et al: Grading quality of evidence and strength of recommendations in clinical practice guidelines part 3 of 3. The GRADE approach to developing recommendations. Allergy 66:588-95, 2011

Abbreviations

ASCO: American Society of Clinical Oncology

ER: estrogen receptor

HER2: Human Epidermal Growth Factor Receptor 2

PgR: progesterone receptor

T-DM1: trastuzumab emtansine

Source Citation

Giordano SH, Franzoi MB, Temin S, et al. Systemic Therapy for Advanced Human Epidermal Growth Factor Receptor 2–Positive Breast Cancer: ASCO Guideline Update. J Clin Oncol. 2022 May 31. doi: 10.1200/JCO.22.00519.

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 © 2022 by American Society of Clinical Oncology. All rights reserved.

Advanced Human Epidermal Growth Factor Receptor 2-Positive Breast Cancer

Key Points

Treatment

HER2+

First-Line

Recommendation 1.0

Recommendation 1.1

Second-Line

Recommendation 2.0

Recommendation 2.1 (updated)

Third-Line

Recommendation 3.0

Recommendation 3.1 (updated)

Recommendation 3.1.1 (updated)

Recommendation 3.1.2 (updated)

Recommendation 3.1.3 (updated)

Recommendation 3.1.4 (updated)

Recommendation 3.1.5

Recommendation 3.1.6

Recommendation 3.1.7

Recommendation 3.1.8 (updated)

Recommendation 3.1.9

Recommendation 3.2.0

Recommendation 3.2.1 (updated)

Timing, Dose, Schedule, and Duration

Recommendation 4.0

Recurrence

Recommendation 5.0

Recommendation 5.1

HER2+, ER+, PgR+

First-Line

Recommendation 6.0

Recommendation 6.0.1

Recommendation 6.0.2

Recommendation 6.0.3

Endocrine Therapy Sequencing

Recommendation 7.0

First-Line Endocrine Therapy

Recommendation 8.0

Figure 1. Algorithm for Patients with HER2+ Advanced Disease