scholarly journals Adjuvant Endocrine Therapy for Women With Hormone Receptor–Positive Breast Cancer: American Society of Clinical Oncology Clinical Practice Guideline Update on Ovarian Suppression Summary

2016 ◽  
Vol 12 (4) ◽  
pp. 390-393 ◽  
Author(s):  
Harold J. Burstein ◽  
Christina Lacchetti ◽  
Jennifer J. Griggs
Keyword(s):  
Breast Cancer ◽  
Clinical Practice ◽  
Endocrine Therapy ◽  
Clinical Oncology ◽  
Clinical Practice Guideline ◽  
Practice Guideline ◽  
Hormone Receptor ◽  
Hormone Receptor Positive ◽  
American Society ◽  
Positive Breast Cancer

scholarly journals American Society of Clinical Oncology Clinical Practice Guideline Update on Adjuvant Endocrine Therapy for Women With Hormone Receptor–Positive Breast Cancer

2010 ◽  
Vol 6 (5) ◽  
pp. 243-246 ◽  
Author(s):  
Harold J. Burstein ◽  
Jennifer J. Griggs ◽  
Ann A. Prestrud ◽  
Sarah Temin
Keyword(s):  
Breast Cancer ◽  
Clinical Practice ◽  
Aromatase Inhibitors ◽  
Clinical Practice Guideline ◽  
Technology Assessment ◽  
Practice Guideline ◽  
Adjuvant Setting ◽  
Hormone Receptor Positive ◽  
American Society ◽  
Positive Breast Cancer

ASCO's technology assessment of the use of aromatase inhibitors in the adjuvant setting was last updated in 2004. ASCO's Update Committee on Aromatase Inhibitors reconvened in May 2009 to update this guideline.

scholarly journals American Society of Clinical Oncology Clinical Practice Guideline: Update on Adjuvant Endocrine Therapy for Women With Hormone Receptor–Positive Breast Cancer

2010 ◽  
Vol 28 (23) ◽  
pp. 3784-3796 ◽  
Author(s):  
Harold J. Burstein ◽  
Ann Alexis Prestrud ◽  
Jerome Seidenfeld ◽  
Holly Anderson ◽  
Thomas A. Buchholz ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Adverse Effect ◽  
Postmenopausal Women ◽  
Endocrine Therapy ◽  
Clinical Oncology ◽  
Adjuvant Treatment ◽  
Hormone Receptor ◽  
Hormone Receptor Positive ◽  
American Society ◽  
Positive Breast Cancer

PurposeTo develop evidence-based guidelines, based on a systematic review, for endocrine therapy for postmenopausal women with hormone receptor–positive breast cancer.MethodsA literature search identified relevant randomized trials. Databases searched included MEDLINE, PREMEDLINE, the Cochrane Collaboration Library, and those for the Annual Meetings of the American Society of Clinical Oncology (ASCO) and the San Antonio Breast Cancer Symposium (SABCS). The primary outcomes of interest were disease-free survival, overall survival, and time to contralateral breast cancer. Secondary outcomes included adverse events and quality of life. An expert panel reviewed the literature, especially 12 major trials, and developed updated recommendations.ResultsAn adjuvant treatment strategy incorporating an aromatase inhibitor (AI) as primary (initial endocrine therapy), sequential (using both tamoxifen and an AI in either order), or extended (AI after 5 years of tamoxifen) therapy reduces the risk of breast cancer recurrence compared with 5 years of tamoxifen alone. Data suggest that including an AI as primary monotherapy or as sequential treatment after 2 to 3 years of tamoxifen yields similar outcomes. Tamoxifen and AIs differ in their adverse effect profiles, and these differences may inform treatment preferences.ConclusionThe Update Committee recommends that postmenopausal women with hormone receptor–positive breast cancer consider incorporating AI therapy at some point during adjuvant treatment, either as up-front therapy or as sequential treatment after tamoxifen. The optimal timing and duration of endocrine treatment remain unresolved. The Update Committee supports careful consideration of adverse effect profiles and patient preferences in deciding whether and when to incorporate AI therapy.

scholarly journals Adjuvant Endocrine Therapy for Women With Hormone Receptor–Positive Breast Cancer: American Society of Clinical Oncology Clinical Practice Guideline Focused Update

2014 ◽  
Vol 32 (21) ◽  
pp. 2255-2269 ◽  
Author(s):  
Harold J. Burstein ◽  
Sarah Temin ◽  
Holly Anderson ◽  
Thomas A. Buchholz ◽  
Nancy E. Davidson ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Clinical Practice ◽  
Aromatase Inhibitor ◽  
Endocrine Therapy ◽  
Clinical Practice Guideline ◽  
Adjuvant Endocrine Therapy ◽  
Tamoxifen Treatment ◽  
Adjuvant Tamoxifen ◽  
Hormone Receptor Positive ◽  
Positive Breast Cancer

PurposeTo update the ASCO clinical practice guideline on adjuvant endocrine therapy on the basis of emerging data on the optimal duration of treatment, particularly adjuvant tamoxifen.MethodsASCO convened the Update Committee and conducted a systematic review of randomized clinical trials from January 2009 to June 2013 and analyzed three historical trials. Guideline recommendations were based on the Update Committee's review of the evidence. Outcomes of interest included survival, disease recurrence, and adverse events.ResultsThis guideline update reflects emerging data on duration of tamoxifen treatment. There have been five studies of tamoxifen treatment beyond 5 years of therapy. The two largest studies with longest reported follow-up show a breast cancer survival advantage with 10-year durations of tamoxifen use. In addition to modest gains in survival, extended therapy with tamoxifen for 10 years compared with 5 years was associated with lower risks of breast cancer recurrence and contralateral breast cancer.RecommendationsPrevious ASCO guidelines recommended treatment of women who have hormone receptor–positive breast cancer and are premenopausal with 5 years of tamoxifen, and those who are postmenopausal a minimum of 5 years of adjuvant therapy with an aromatase inhibitor or tamoxifen followed by an aromatase inhibitor (in sequence). If women are pre- or perimenopausal and have received 5 years of adjuvant tamoxifen, they should be offered 10 years total duration of tamoxifen. If women are postmenopausal and have received 5 years of adjuvant tamoxifen, they should be offered the choice of continuing tamoxifen or switching to an aromatase inhibitor for 10 years total adjuvant endocrine therapy.

Adjuvant Endocrine Therapy for Women With Hormone Receptor–Positive Breast Cancer: ASCO Clinical Practice Guideline Focused Update

2019 ◽  
Vol 37 (5) ◽  
pp. 423-438 ◽  
Author(s):  
Harold J. Burstein ◽  
Christina Lacchetti ◽  
Holly Anderson ◽  
Thomas A. Buchholz ◽  
Nancy E. Davidson ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Clinical Practice ◽  
Endocrine Therapy ◽  
Clinical Practice Guideline ◽  
Practice Guideline ◽  
Cancer Recurrence ◽  
Endocrine Treatment ◽  
Breast Cancers ◽  
Node Negative ◽  
Positive Breast Cancer

Purpose To update the ASCO clinical practice guideline on adjuvant endocrine therapy based on emerging data about the optimal duration of aromatase inhibitor (AI) treatment. Methods ASCO conducted a systematic review of randomized clinical trials from 2012 to 2018. Guideline recommendations were based on the Panel’s review of the evidence from six trials. Results The six included studies of AI treatment beyond 5 years of therapy demonstrated that extension of AI treatment was not associated with an overall survival advantage but was significantly associated with lower risks of breast cancer recurrence and contralateral breast cancer compared with placebo. Bone-related toxic effects were more common with extended AI treatment. Recommendations The Panel recommends that women with node-positive breast cancer receive extended therapy, including an AI, for up to a total of 10 years of adjuvant endocrine treatment. Many women with node-negative breast cancer should consider extended therapy for up to a total of 10 years of adjuvant endocrine treatment based on considerations of recurrence risk using established prognostic factors. The Panel noted that the benefits in absolute risk of reduction were modest and that, for lower-risk node-negative or limited node-positive cancers, an individualized approach to treatment duration that is based on considerations of risk reduction and tolerability was appropriate. A substantial portion of the benefit for extended adjuvant AI therapy was derived from prevention of second breast cancers. Shared decision making between clinicians and patients is appropriate for decisions about extended adjuvant endocrine treatment, including discussions about the absolute benefits in the reduction of breast cancer recurrence, the prevention of second breast cancers, and the impact of adverse effects of treatment. Additional information can be found at www.asco.org/breast-cancer-guidelines .

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