ASCO calls for 10 years of AI therapy in node-positive breast cancer

  • Burstein HJ & al.
  • J Clin Oncol
  • 19 Nov 2018

  • Oncology guidelines update
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Takeaway

  • A new clinical practice guideline from the American Society of Clinical Oncology (ASCO) recommends extending aromatase inhibitor (AI) therapy from 5 years up to 10 years in postmenopausal women with node-positive hormone receptor (HR)-positive early breast cancer (eBCa).
  • Low-risk, node-negative cases should not be routinely offered more than 5 years of AI therapy.

Why this matters

  • 2016 ASCO guidelines recommended 5 years of AI therapy for all cases.
  • New evidence from 6 randomized controlled trials (RCTs) found that extending AI therapy beyond 5 years had no survival advantage but did cut the risk for distant recurrence and contralateral breast cancer vs placebo.

Study design

  • An expert panel reviewed the 6 new RCTs and formulated 5 recommendations.
  • Funding: None disclosed.

Recommendations

  • Patients with node-positive, postmenopausal HR+ eBCa should be offered up to 10 years of adjuvant AI therapy.
  • Node-negative cases may be offered up to 10 years of AI therapy, but low-risk node-negative cases should not be routinely offered more than 5 years AI therapy.
  • No more than 10 years of AI therapy should be given.
  • The risk for a second BCa, based on prior therapy, should feed into treatment decisions about extended AI therapy.
  • Decision-making should be shared between the clinical team and the patient, with full disclosure of risks and benefits.

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