'Got It Right': Guidelines for HER2-Negative Breast Cancer

Kathy D. Miller, MD


September 10, 2014

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Hi. This is Dr. Kathy Miller, from Indiana University. The American Society of Clinical Oncology just released its newest clinical practice guideline,[1] for the first time taking a look at the optimal treatment of patients with HER-2 negative advanced metastatic breast cancer.

Unlike some guidelines and pathways that might try to drill down to a specific treatment recommendation, this guideline takes a broader-picture view and outlines a series of principles. From my perspective, they got it exactly right.

The guideline authors acknowledge that metastatic breast cancer is not curable and patients need to understand that. Patients need to be offered clinical trials. The guideline points out that hormone therapy is the mainstay of treatment and should be the first option for patients with estrogen-positive metastatic disease. The authors strongly recommend the sequential use of chemotherapy, rather than the combined use of two or three agents simultaneously, and suggest that palliative care be incorporated into treatment early. Furthermore, they suggest that patients and doctors should make treatment choices together. There simply is no optimal agent, or no optimal order in which agents ought to be given. The unique toxicities and schedules of these agents allow room for individualized treatment choices, but those choices need to be made together, with well-informed patients and physicians having those difficult conversations.

Take a look.


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