Key Points

Treatment

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

Selection of Optimal Adjuvant Chemotherapy and Targeted Therapy for Early Breast Cancer

American Society of Clinical Oncology

Publication Date: May 20, 2024

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

CCO: Cancer Care Ontario

DFS: disease-free survival

ER: estrogen receptor

HER2: Human Epidermal Growth Factor Receptor 2

IV: intravenous

OS: overall survival

TAILORx: Trial Assigning Individualized Options for Treatment

Source Citation

Freedman RA, Caswell-Jin J, Hassett M, et al. Optimal Adjuvant Chemotherapy and Targeted Therapy for Early Breast Cancer – CDK4/6 Inhibitors: ASCO Rapid Guideline Update. J Clin Oncol. 2024 May 20. doi: 10.1200/JCO.24.00886

Giordano SH, Freedman RA, and Somerfield MR. Abemaciclib with Endocrine Therapy in the Treatment of High-Risk Early Breast Cancer: ASCO Optimal Adjuvant Chemotherapy and Targeted Therapy Guideline Rapid Recommendation Update. J Clin Oncol. 2022 Jan 20;40(3):307-309

Denduluri N, Somerfield MR, Chavez-MacGregor M, et al. Selection of Optimal Adjuvant Chemotherapy and Targeted Therapy for Early Breast Cancer: ASCO Guideline Update. J Clin Oncol. 2021 Feb 20;39(6):685-693.

Denduluri N, Chavez-MacGregor M, Telli ML, et al. Selection of Optimal Adjuvant Chemotherapy and Targeted Therapy for Early Breast Cancer: ASCO Clinical Practice Guideline Focused Update. J Clin Oncol. 2018;36(23):2433-2443.

Denduluri N, Somerfield MR, Eisen A, et al. Selection of Optimal Adjuvant Chemotherapy Regimens for Human Epidermal Growth Factor Receptor 2 (HER2)-Negative and Adjuvant Targeted Therapy for HER2-Positive Breast Cancers: An American Society of Clinical Oncology Guideline Adaptation of the Cancer Care Ontario Clinical Practice Guideline. J Clin Oncol. 2016 Jul 10;34(20):2416-2427.

Eisen A, Fletcher GG, Gandhi S, et al. Optimal systemic therapy for early breast cancer in women: A clinical practice guideline. Curr Oncol. 22:S67-S81, 2015 (suppl 1).

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 © 2024 by American Society of Clinical Oncology. All rights reserved.

Selection of Optimal Adjuvant Chemotherapy and Targeted Therapy for Early Breast Cancer

Key Points

Treatment

New Recommendations from 2024 Guideline Rapid Recommendation Update

Use of an Anthracycline-Taxane Regimen

Adding Gemcitabine or Capecitabine to an Anthracycline-Taxane Regimen

Optimal-Dose Anthracycline Regimen for Patients for Whom a Taxane Is Contraindicated

Capecitabine in Patients Age ≥65 Years

Cyclophosphamide-Methotrexate-Fluorouracil As an Alternative To Doxorubicin-Cyclophosphamide

Acceptable Adjuvant Chemotherapy Regimens for Patients with Higher-Risk Early Breast Cancer

Adjuvant Regimen When an Anthracycline Is Not Preferred

Patient Selection and Adjuvant Trastuzumab Therapy

Trastuzumab Plus Chemotherapy in Patients with Higher-Risk HER2-Positive Disease

Trastuzumab Plus Chemotherapy in Patients with HER2-Positive T1a-B N0 Disease

Selection of Chemotherapy Regimens in Patients Receiving Trastuzumab

Use of Trastuzumab and an Anthracycline-Containing Regimen

Concurrent Administration of Adjuvant Trastuzumab and Non-Anthracycline Chemotherapy Regimens

Trastuzumab-Based Chemotherapy or Trastuzumab Regimens For Patients at Higher Risk of Cardiotoxicity

Addition of Trastuzumab to Chemotherapy Regimens Not Evaluated in a Phase III Trial

Duration of Trastuzumab Therapy and Cardiac Function

Adjuvant Capecitabine

Adjuvant Pertuzumab

Adjuvant Neratinib