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In Journal of clinical oncology : official journal of the American Society of Clinical Oncology

PURPOSE : This guideline updates recommendations of the ASCO guideline on chemotherapy and targeted therapy for patients with human epidermal growth factor receptor 2-negative metastatic breast cancer (MBC) that is either endocrine-pretreated or hormone receptor (HR)-negative.

METHODS : An Expert Panel conducted a targeted systematic literature review guided by a signals approach to identify new, potentially practice-changing data that might translate into revised guideline recommendations.

RESULTS : The Expert Panel reviewed abstracts from the literature review and retained 14 articles.

RECOMMENDATIONS : Patients with triple-negative, programmed cell death ligand-1-positive MBC may be offered the addition of immune checkpoint inhibitor to chemotherapy as first-line therapy. Patients with triple-negative, programmed cell death ligand-1-negative MBC should be offered single-agent chemotherapy rather than combination chemotherapy as first-line treatment, although combination regimens may be offered for life-threatening disease. Patients with triple-negative MBC who have received at least two prior therapies for MBC should be offered treatment with sacituzumab govitecan. Patients with triple-negative MBC with germline BRCA mutations previously treated with chemotherapy may be offered a poly (ADP-ribose) polymerase inhibitor rather than chemotherapy. Patients with HR-positive human epidermal growth factor receptor 2-negative MBC for whom chemotherapy is being considered should be offered single-agent chemotherapy rather than combination chemotherapy, although combination regimens may be offered for highly symptomatic or life-threatening disease. Patients with HR-positive MBC with disease progression on an endocrine agent may be offered treatment with either endocrine therapy with or without targeted therapy or single-agent chemotherapy. Patients with HR-positive MBC with germline BRCA mutations no longer benefiting from endocrine therapy may be offered a poly (ADP-ribose) polymerase inhibitor rather than chemotherapy. No recommendation regarding when a patient's care should be transitioned to hospice or best supportive care alone is possible.Additional information is available at www.asco.org/breast-cancer-guidelines.

Moy Beverly, Rumble R Bryan, Come Steven E, Davidson Nancy E, Di Leo Angelo, Gralow Julie R, Hortobagyi Gabriel N, Yee Douglas, Smith Ian E, Chavez-MacGregor Mariana, Nanda Rita, McArthur Heather L, Spring Laura, Reeder-Hayes Katherine E, Ruddy Kathryn J, Unger Paul S, Vinayak Shaveta, Irvin William J, Armaghani Avan, Danso Michael A, Dickson Natalie, Turner Sophie S, Perkins Cheryl L, Carey Lisa A

2021-Jul-29