Recommendations on disease management for patients with advanced human epidermal growth factor receptor 2-positive breast cancer and brain metastases: American Society of Clinical Oncology Clinical Practice Guideline Journal Article


Authors: Ramakrishna, N.; Temin, S.; Chandarlapaty, S.; Crews, J. R.; Davidson, N. E.; Esteva, F. J.; Giordano, S. H.; Gonzalez-Angulo, A. M.; Kirshner, J. J.; Krop, I.; Levinson, J.; Modi, S.; Patt, D. A.; Perez, E. A.; Perlmutter, J.; Winer, E. P.; Lin, N. U.
Article Title: Recommendations on disease management for patients with advanced human epidermal growth factor receptor 2-positive breast cancer and brain metastases: American Society of Clinical Oncology Clinical Practice Guideline
Abstract: Purpose To provide formal expert consensus-based recommendations to practicing oncologists and others on the management of brain metastases for patients with human epidermal growth factor receptor 2 (HER2) -positive advanced breast cancer. Methods The American Society of Clinical Oncology (ASCO) convened a panel of medical oncology, radiation oncology, guideline implementation, and advocacy experts and conducted a systematic review of the literature. When that failed to yield sufficiently strong quality evidence, the Expert Panel undertook a formal expert consensus-based process to produce these recommendations. ASCO used a modified Delphi process. The panel members drafted recommendations, and a group of other experts joined them for two rounds of formal ratings of the recommendations. Results No studies or existing guidelines met the systematic review criteria; therefore, ASCO conducted a formal expert consensus-based process. Recommendations Patients with brain metastases should receive appropriate local therapy and systemic therapy, if indicated. Local therapies include surgery, whole-brain radiotherapy, and stereotactic radiosurgery. Treatments depend on factors such as patient prognosis, presence of symptoms, resectability, number and size of metastases, prior therapy, and whether metastases are diffuse. Other options include systemic therapy, best supportive care, enrollment onto a clinical trial, and/or palliative care. Clinicians should not perform routine magnetic resonance imaging (MRI) to screen for brain metastases, but rather should have a low threshold for MRI of the brain because of the high incidence of brain metastases among patients with HER2-positive advanced breast cancer. (c) 2014 by American Society of Clinical Oncology
Keywords: survival; radiosurgery; surgical resection; trastuzumab; phase-ii; radiation-therapy; adjuvant; nervous-system metastases; stereotactic; cerebral metastases; tumor subtype; lapatinib plus capecitabine
Journal Title: Journal of Clinical Oncology
Volume: 32
Issue: 19
ISSN: 0732-183X
Publisher: American Society of Clinical Oncology  
Date Published: 2014-07-01
Start Page: 2100
End Page: 2108
Language: English
ACCESSION: WOS:000337925500018
DOI: 10.1200/jco.2013.54.0955
PROVIDER: wos
PUBMED: 24799487
PMCID: PMC6366342
Notes: Article -- Source: Wos
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  1. Shanu Modi
    172 Modi