As reported in the Journal of Clinical Oncology by N. Lynn Henry, MD, PhD, of the University of Michigan Comprehensive Cancer Center, and colleagues, ASCO has endorsed Cancer Care Ontario (CCO) guideline recommendations on the role of patient and disease factors in decisions on adjuvant systemic therapy in early-stage operable breast cancer. Endorsement was based on review by an ASCO expert panel, co-chaired by Dr. Henry and Ian E. Krop, MD, PhD, of Dana-Farber Cancer Institute.
The primary CCO guideline question considered was: Which patient and disease factors should be considered in selecting adjuvant therapy for women with early-stage breast cancer? The target population is women who are being considered for or who are receiving systemic therapy for early-stage invasive breast cancer (stages I–IIA, T1N0–1, T2N0). CCO recommendations and select ASCO panel discussion points are summarized below.
ASCO Panel Discussion Points
In its discussion points, the ASCO panel highlighted three areas thought to warrant further consideration: tumor histology and adjuvant therapy recommendations, risk-stratification tools and proposed Oncotype DX RS thresholds to guide decisions about chemotherapy, and patient factors in decision-making. The panel noted that some uncommon breast cancer subtypes (eg, tubular, mucinous) may have a favorable prognosis and that such histologic information may be relevant for making decisions regarding adjuvant chemotherapy. The panel also noted that factors such as grade 3 disease and lymphovascular invasion generally should not be used in isolation in decision-making but considered within the overall clinical context.
It was pointed out that there are now several risk-stratification tools available in addition to Oncotype DX, with practitioners being referred to the current ASCO guideline on biomarker use in this setting (www.asco.org/guidelines/adjuvantbreastmarkers). The panel further emphasized that patient preferences should play a role in selection of adjuvant systemic therapy. For older patients, it was recommended that validated geriatric assessment tools be used to evaluate life expectancy and such factors as functional status, comorbidity, cognitive function, and social support in making decisions regarding adjuvant therapy.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.