Selection of Optimal Adjuvant Chemotherapy and Targeted Therapy for Early Breast Cancer: ASCO Clinical Practice Guideline Focused Update Summary

In 2016, ASCO published an adaptation of the Cancer Care Ontario (CCO) guideline on the selection of optimal adjuvant chemotherapy regimens for early breast cancer and adjuvant targeted therapy for human epidermal growth factor receptor 2 (HER2)–positive breast cancers.1 ASCO updates its guidelines at intervals determined by an Update Steering Group of the original Expert Panel. The recent publication of phase III studies2-5 relevant to the clinical care of breast cancer patients prompted this update. The focused update of the 2016 guideline adaptation provides new recommendations for (1) the addition of adjuvant capecitabine after completion of standard preoperative anthracycline and taxane-based combination chemotherapy in patients with early-stage HER2-negative breast cancer with residual disease at surgery, (2) the addition of 1 year of adjuvant pertuzumab to combination chemotherapy and trastuzumab, and (3) the use of neratinib as extended adjuvant therapy in patients with early-stage HER2 amplified or overexpressed breast cancer. The remaining recommendations from the 2016 ASCO guideline adaptation are unchanged because there were no new potentially practice-changing data to support substantive revisions. Additional information is available at www.asco.org/breast-cancer-guidelines. Patient information is available at www.cancer.net. THE BOTTOM LINE Selection of Optimal Adjuvant Chemotherapy and Targeted Therapy for Early Breast Cancer: ASCO Clinical Practice Guideline Focused Update Questions Addressed in Focused Update Should adjuvant capecitabine be given after completion of standard preoperative anthracycline and taxane-based combination chemotherapy in patients with early-stage human epidermal growth factor receptor 2 (HER2)–negative breast cancer with residual invasive disease at surgery? Should 1 year of adjuvant pertuzumab be added to trastuzumab-based combination chemotherapy in patients with early-stage HER2-positive breast cancer? Should neratinib be offered as extended adjuvant therapy for patients after combination chemotherapy and trastuzumab-based adjuvant therapy with early-stage, HER2-positive breast cancer? Target Population Patients who are being considered for, or who are receiving, systemic therapy after definitive surgery for early-stage invasive breast cancer, defined largely as invasive cancer anatomic stages I to IIIC Target Audience Medical oncologists, pathologists, surgeons, oncology nurses, patients, and caregivers. Methods An Expert Panel was convened to develop clinical practice guideline recommendations based on a