【原】HER2阳性乳腺癌辅助靶向疗法和早期乳腺癌辅助辅助化疗方案优化选择：美国临床肿瘤学会参考安大略癌症诊疗临床实践指南的指南修订

　　2016年4月18日，美国临床肿瘤学会（ASCO）官方期刊《临床肿瘤学杂志》（JCO）在线发表了ASCO参考加拿大安大略癌症诊疗（CCO）临床实践指南的指南修订推荐意见：HER2阳性乳腺癌辅助靶向疗法和早期乳腺癌辅助辅助化疗方案优化选择。

J Clin Oncol. 2016 Apr 18. [Epub ahead of print]

Selection of Optimal Adjuvant Chemotherapy Regimens for Early Breast Cancer and Adjuvant Targeted Therapy for Human Epidermal Growth Factor Receptor 2-Positive Breast Cancers: An American Society of Clinical Oncology Guideline Adaptation of the Cancer Care Ontario Clinical Practice Guideline.

Neelima Denduluri, Mark R. Somerfield, Andrea Eisen, Jamie N. Holloway, Arti Hurria, Tari A. King, Gary H. Lyman, Ann H. Partridge, Melinda L. Telli, Maureen E. Trudeau, Antonio C. Wolff.

• US Oncology Network, Virginia Cancer Specialists, Arlington, VA.

• American Society of Clinical Oncology, Alexandria, VA.

• Sunnybrook Health Sciences Centre, Cancer Care Ontario, Toronto, Ontario, Canada.

• City of Hope, Duarte, CA.

• Stanford University, Palo Alto, CA.

• Dana-Farber/Brigham and Women's Cancer Center, Dana-Farber Cancer Institute, Boston, MA.

• Fred Hutchinson Cancer Research Center, Seattle, WA.

• The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD.

PURPOSE: A Cancer Care Ontario (CCO) guideline on the selection of optimal adjuvant chemotherapy regimens for early breast cancer including adjuvant targeted therapy for human epidermal growth factor receptor 2 (HER2)-positive breast cancers was identified for adaptation.

METHODS: The American Society of Clinical Oncology (ASCO) has a policy and set of procedures for adapting clinical practice guidelines developed by other organizations. The CCO guideline was reviewed for developmental rigor and content applicability.

RESULTS: On the basis of the content review of the CCO guideline, the ASCO Panel agreed that, in general, the recommendations were clear and thorough and were based on the most relevant scientific evidence, and they presented options that will be acceptable to patients. However, for some topics addressed in the CCO guideline, the ASCO Panel formulated a set of adapted recommendations on the basis of local context and practice beliefs of the Panel members.

RECOMMENDATIONS: Decisions regarding adjuvant chemotherapy regimens should take into account baseline recurrence risk, toxicities, likelihood of benefit, and host factors such as comorbidities. In high-risk HER2-negative populations with excellent performance status, anthracycline- and taxane-containing regimens are the standard of care. Docetaxel and cyclophosphamide for four cycles is an acceptable non-anthracycline regimen. In high-risk HER2-positive disease, sequential anthracycline and taxanes administered concurrently with trastuzumab or docetaxel, carboplatin, and trastuzumab for six cycles are recommended. An alternative regimen in a lower-risk, node-negative, HER2-positive population is paclitaxel and trastuzumab once per week for 12 cycles. Trastuzumab should be given for 1 year. Platinum salts should not be routinely administered in the adjuvant triple-negative population until survival efficacy data become available.

DOI: 10.1200/JCO.2016.67.0182