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