ASCO's Breast Cancer Guideline Advisory Group and Clinical Practice Guideline Committee have published an updated guideline in the Journal of Clinical Oncology on using breast cancer biomarkers to guide clinical decisions when treating advanced metastatic breast cancer.
The American Society of Clinical Oncology (ASCO)’s Breast Cancer Guideline Advisory Group and Clinical Practice Guideline Committee have published an updated guideline in the Journal of Clinical Oncology on using breast cancer biomarkers to guide clinical decisions on the use of systemic therapy for advanced metastatic breast cancer. The guideline purports to answer the following questions to help physicians decide on initiating systemic therapy or changing an existing treatment regimen:
A panel of experts conducted an exhaustive literature review to come up with the following recommendations for the above queries:
1. Biopsy
Patients with accessible, newly diagnosed metastases from primary breast cancer should be offered biopsy for confirmation of disease process and testing of ER, PR, and HER2 status. Patients should be informed that in case of a discordance, there is no evidence to determine whether outcomes are better with treatment regimens based on receptor status in the metastases or the primary tumor. With discordance of results between primary and metastatic tissues, the Panel recommends using the ER, PR, and HER2 status from the metastasis to direct therapy, if supported by the clinical scenario and the patient's goals for care.
2. Systemic therapy
Clinical evaluation, judgment, and patient preferences should guide decisions on initiating systemic therapy for metastatic breast cancer. There is no evidence at this time that initiating therapy solely on the basis of biomarker results beyond those of ER, PR, and HER2 improves health outcomes.
3. Switching therapy based on tissue biomarkers or circulating tumor markers
In patients already receiving systemic therapy for metastatic breast cancer, decisions on changing to a new drug or regimen or discontinuing treatment should be based on clinical evaluation, judgment of disease progression or response, and the patient's goals for care. There is no evidence at this time that changing therapy based solely on biomarker results beyond ER, PR, and HER2 improves health outcomes, quality of life, or cost effectiveness.
4. Clinical utility of existing biomarkers
CEA, CA 15-3, and CA 27-29 may be used as adjunctive assessments to contribute to decisions regarding therapy for metastatic breast cancer. Data are insufficient to recommend use of CEA, CA 15-3, and CA 27-29 alone for monitoring response to treatment. The recommendation for use is based on clinical experience and Panel informal consensus in the absence of studies designed to evaluate the clinical utility of the markers. As such, it is also reasonable for clinicians to not use these markers as adjunctive assessments.
The Panel underscored the importance of continuing research in the field of biomarkers to guide treatment decisions, stating that the study of biomarkers has always lagged behind drug development. However, increased funding of biomarker research by the National Cancer Institute, and the investment by the pharmaceutical industry in developing companion diagnostics is changing the scenario.
Real-World Study Reveals Key Insights into DLBCL Treatment Patterns, Outcomes
April 18th 2024A recent study offers valuable insights into the characteristics, treatment patterns, and outcomes of diffuse large B-cell lymphoma (DLBCL) in patients across different lines of therapy, providing a look into the landscape of DLBCL management.
Read More
Pegcetacoplan for PNH More Cost-Effective Than Anti-C5 Monoclonal Antibodies
April 18th 2024A cost-utility analysis conducted from the perspective of the Italian health system found that pegcetacoplan was more effective and less costly than 2 complement 5 (C5) inhibitors for the treatment of paroxysmal nocturnal hemoglobinuria (PNH).
Read More
Oncology Onward: A Conversation With Penn Medicine's Dr Justin Bekelman
December 19th 2023Justin Bekelman, MD, director of the Penn Center for Cancer Care Innovation, sat with our hosts Emeline Aviki, MD, MBA, and Stephen Schleicher, MD, MBA, for our final episode of 2023 to discuss the importance of collaboration between academic medicine and community oncology and testing innovative cancer care delivery in these settings.
Listen
Many Patients With Psoriasis in Clinical Trials Experience Nocebo Effects, Study Finds
April 18th 2024Half of patients exposed to placebo in clinical trials experienced adverse events (AEs), which may be partially explainable by nocebo effects, according to a recent review and meta-analysis.
Read More
Low-Volume Hospitals Had Higher Reoperation Rate, Postoperative Complications in CRC
April 18th 2024Patients opting for elective colorectal surgery to address colorectal cancer (CRC) could have different rates of reoperation and postoperative complications based on the size of the hospital.
Read More