Selection of Optimal Adjuvant Chemotherapy Regimens for Human Epidermal Growth Factor Receptor 2 (HER2) -Negative and Adjuvant Targeted Therapy for HER2-Positive Breast Cancers: An American Society of Clinical Oncology Guideline Adaptation of the Cancer Care Ontario Clinical Practice Guideline.
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.



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.



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.



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.
Neelima Denduluri, US Oncology Network, Virginia Cancer Specialists, Arlington; Jamie N. Holloway, Patient Representative, Arlington; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Andrea Eisen and Maureen E. Trudeau, Sunnybrook Health Sciences Centre, and Cancer Care Ontario, Toronto, Ontario, Canada; Arti Hurria, City of Hope, Duarte; Melinda L. Telli, Stanford University, Palo Alto, CA; Tari A. King, Dana-Farber/Brigham and Women's Cancer Center; Ann H. Partridge, Dana-Farber Cancer Institute, Boston, MA; Gary H. Lyman, Fred Hutchinson Cancer Research Center, Seattle, WA; and Antonio C. Wolff, The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD.
Neelima
N
Denduluri
Neelima Denduluri, US Oncology Network, Virginia Cancer Specialists, Arlington; Jamie N. Holloway, Patient Representative, Arlington; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Andrea Eisen and Maureen E. Trudeau, Sunnybrook Health Sciences Centre, and Cancer Care Ontario, Toronto, Ontario, Canada; Arti Hurria, City of Hope, Duarte; Melinda L. Telli, Stanford University, Palo Alto, CA; Tari A. King, Dana-Farber/Brigham and Women's Cancer Center; Ann H. Partridge, Dana-Farber Cancer Institute, Boston, MA; Gary H. Lyman, Fred Hutchinson Cancer Research Center, Seattle, WA; and Antonio C. Wolff, The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD.
Mark R
MR
Somerfield
Neelima Denduluri, US Oncology Network, Virginia Cancer Specialists, Arlington; Jamie N. Holloway, Patient Representative, Arlington; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Andrea Eisen and Maureen E. Trudeau, Sunnybrook Health Sciences Centre, and Cancer Care Ontario, Toronto, Ontario, Canada; Arti Hurria, City of Hope, Duarte; Melinda L. Telli, Stanford University, Palo Alto, CA; Tari A. King, Dana-Farber/Brigham and Women's Cancer Center; Ann H. Partridge, Dana-Farber Cancer Institute, Boston, MA; Gary H. Lyman, Fred Hutchinson Cancer Research Center, Seattle, WA; and Antonio C. Wolff, The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD.
Andrea
A
Eisen
Neelima Denduluri, US Oncology Network, Virginia Cancer Specialists, Arlington; Jamie N. Holloway, Patient Representative, Arlington; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Andrea Eisen and Maureen E. Trudeau, Sunnybrook Health Sciences Centre, and Cancer Care Ontario, Toronto, Ontario, Canada; Arti Hurria, City of Hope, Duarte; Melinda L. Telli, Stanford University, Palo Alto, CA; Tari A. King, Dana-Farber/Brigham and Women's Cancer Center; Ann H. Partridge, Dana-Farber Cancer Institute, Boston, MA; Gary H. Lyman, Fred Hutchinson Cancer Research Center, Seattle, WA; and Antonio C. Wolff, The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD.
Jamie N
JN
Holloway
Neelima Denduluri, US Oncology Network, Virginia Cancer Specialists, Arlington; Jamie N. Holloway, Patient Representative, Arlington; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Andrea Eisen and Maureen E. Trudeau, Sunnybrook Health Sciences Centre, and Cancer Care Ontario, Toronto, Ontario, Canada; Arti Hurria, City of Hope, Duarte; Melinda L. Telli, Stanford University, Palo Alto, CA; Tari A. King, Dana-Farber/Brigham and Women's Cancer Center; Ann H. Partridge, Dana-Farber Cancer Institute, Boston, MA; Gary H. Lyman, Fred Hutchinson Cancer Research Center, Seattle, WA; and Antonio C. Wolff, The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD.
Arti
A
Hurria
Neelima Denduluri, US Oncology Network, Virginia Cancer Specialists, Arlington; Jamie N. Holloway, Patient Representative, Arlington; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Andrea Eisen and Maureen E. Trudeau, Sunnybrook Health Sciences Centre, and Cancer Care Ontario, Toronto, Ontario, Canada; Arti Hurria, City of Hope, Duarte; Melinda L. Telli, Stanford University, Palo Alto, CA; Tari A. King, Dana-Farber/Brigham and Women's Cancer Center; Ann H. Partridge, Dana-Farber Cancer Institute, Boston, MA; Gary H. Lyman, Fred Hutchinson Cancer Research Center, Seattle, WA; and Antonio C. Wolff, The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD.
Tari A
TA
King
Neelima Denduluri, US Oncology Network, Virginia Cancer Specialists, Arlington; Jamie N. Holloway, Patient Representative, Arlington; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Andrea Eisen and Maureen E. Trudeau, Sunnybrook Health Sciences Centre, and Cancer Care Ontario, Toronto, Ontario, Canada; Arti Hurria, City of Hope, Duarte; Melinda L. Telli, Stanford University, Palo Alto, CA; Tari A. King, Dana-Farber/Brigham and Women's Cancer Center; Ann H. Partridge, Dana-Farber Cancer Institute, Boston, MA; Gary H. Lyman, Fred Hutchinson Cancer Research Center, Seattle, WA; and Antonio C. Wolff, The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD.
Gary H
GH
Lyman
Neelima Denduluri, US Oncology Network, Virginia Cancer Specialists, Arlington; Jamie N. Holloway, Patient Representative, Arlington; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Andrea Eisen and Maureen E. Trudeau, Sunnybrook Health Sciences Centre, and Cancer Care Ontario, Toronto, Ontario, Canada; Arti Hurria, City of Hope, Duarte; Melinda L. Telli, Stanford University, Palo Alto, CA; Tari A. King, Dana-Farber/Brigham and Women's Cancer Center; Ann H. Partridge, Dana-Farber Cancer Institute, Boston, MA; Gary H. Lyman, Fred Hutchinson Cancer Research Center, Seattle, WA; and Antonio C. Wolff, The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD.
Ann H
AH
Partridge
Neelima Denduluri, US Oncology Network, Virginia Cancer Specialists, Arlington; Jamie N. Holloway, Patient Representative, Arlington; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Andrea Eisen and Maureen E. Trudeau, Sunnybrook Health Sciences Centre, and Cancer Care Ontario, Toronto, Ontario, Canada; Arti Hurria, City of Hope, Duarte; Melinda L. Telli, Stanford University, Palo Alto, CA; Tari A. King, Dana-Farber/Brigham and Women's Cancer Center; Ann H. Partridge, Dana-Farber Cancer Institute, Boston, MA; Gary H. Lyman, Fred Hutchinson Cancer Research Center, Seattle, WA; and Antonio C. Wolff, The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD.
Melinda L
ML
Telli
Neelima Denduluri, US Oncology Network, Virginia Cancer Specialists, Arlington; Jamie N. Holloway, Patient Representative, Arlington; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Andrea Eisen and Maureen E. Trudeau, Sunnybrook Health Sciences Centre, and Cancer Care Ontario, Toronto, Ontario, Canada; Arti Hurria, City of Hope, Duarte; Melinda L. Telli, Stanford University, Palo Alto, CA; Tari A. King, Dana-Farber/Brigham and Women's Cancer Center; Ann H. Partridge, Dana-Farber Cancer Institute, Boston, MA; Gary H. Lyman, Fred Hutchinson Cancer Research Center, Seattle, WA; and Antonio C. Wolff, The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD.
Maureen E
ME
Trudeau
Neelima Denduluri, US Oncology Network, Virginia Cancer Specialists, Arlington; Jamie N. Holloway, Patient Representative, Arlington; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Andrea Eisen and Maureen E. Trudeau, Sunnybrook Health Sciences Centre, and Cancer Care Ontario, Toronto, Ontario, Canada; Arti Hurria, City of Hope, Duarte; Melinda L. Telli, Stanford University, Palo Alto, CA; Tari A. King, Dana-Farber/Brigham and Women's Cancer Center; Ann H. Partridge, Dana-Farber Cancer Institute, Boston, MA; Gary H. Lyman, Fred Hutchinson Cancer Research Center, Seattle, WA; and Antonio C. Wolff, The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD.
Antonio C
AC
Wolff
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000737:chemistry / Q000188:drug therapy*; D005260:Female; D006801:Humans; D017410:Practice Guidelines as Topic; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000032:analysis*
D018719:Erb-b2 Receptor Tyrosine Kinases; C508053:ERBB2 protein, human