Update on guidelines for the use of adjuvant chemotherapy and targeted therapy in breast cancer patients.

This report summarized updates made to the guidelines for treatment of HER2-positive breast cancer with adjuvant chemotherapy and targeted therapy. 

Adjuvant chemotherapy (treatment after surgery) is often used to prevent cancer recurrence. Chemotherapy involves agents that work to kill cancer cells in the body. This is useful for patients with all subtypes of breast cancer. Patients with HER2-positive breast cancer (dependent on HER2 for growth) also benefit from patients that target the HER2 receptor.

The American Society for Clinical Oncology (ASCO) review and adapt guidelines made by other organizations. The Cancer Care Ontario (CCO) had previously published guidelines on adjuvant chemotherapy for early breast cancer (BC) and adjuvant targeted therapy for HER2-positive BC. 

The ASCO panel reviewed the guidelines previously set out by CCO. The ASCO have recommended some adjustments to the CCO guidelines.

It was recommended that when choosing an adjuvant chemotherapy, other diseases, the chance of recurrence and likelihood of benefit should be considered.

High-risk HER2 negative patients should be treated using chemotherapy regimens that include anthracyclines and taxanes. Doxorubicin (Adriamycin) is a common anthracycline. Docetaxel (Taxotere) is a common taxane. For patients who cannot tolerate an anthracycline chemotherapy regimen, four cycles of docetaxel and cyclophosphamide (Cytoxan) are recommended. Cyclophosphamide, methotrexate (Trexall), and fluorouracil (5-FU, or Adrucil) is also an acceptable combination. 

The recommended treatment regimen for high-risk HER2-positive BC is anthracycline and taxanes combined with trastuzumab (Herceptin). Trastuzumab is a therapy that targets the HER2 receptor, slowing cancer growth. It is not recommended that trastuzumab be given at the same time as an anthracycline. Docetaxel, carboplatin and trastuzumab for six cycles is another option, particularly for patients who are at high risk for heart problems (cardiotoxicity).

Low-risk HER2-positive BC should be treated with paclitaxel (Taxol) and trastuzumab for twelve cycles.  

The report outlines the adaptations made by the ASCO to the CCO guidelines for chemotherapy and targeted therapy in breast cancer patients.