Partridge Ann H, Rumble R Bryan, Carey Lisa A, Come Steven E, Davidson Nancy E, Di Leo Angelo, Gralow Julie, Hortobagyi Gabriel N, Moy Beverly, Yee Douglas, Brundage Shelley B, Danso Michael A, Wilcox Maggie, Smith Ian E
Ann H. Partridge, Dana-Farber Cancer Institute; Steven E. Come, Beth Israel Deaconess Medical Center; Beverly Moy, Massachusetts General Hospital, Boston, MA; R. Bryan Rumble, American Society of Clinical Oncology, Alexandria; Michael A. Danso, Virginia Oncology Associates, Norfolk, VA; Lisa A. Carey, University of North Carolina, Chapel Hill, NC; Nancy E. Davidson, University of Pittsburgh Cancer Institute/University of Pittsburgh Medical Center, Pittsburgh, PA; Angelo Di Leo, Sandro Pitigliani Medical Oncology Unit, Prato, Italy; Julie Gralow, University of Washington/Seattle Cancer Care Alliance, Seattle, WA; Gabriel N. Hortobagyi, The University of Texas MD Anderson Cancer Center, Houston, TX; Douglas Yee, University of Minnesota/Masonic Cancer Center, Minneapolis, MN; Shelley B. Brundage, Patient Representative, Washington, DC; Maggie Wilcox, Independent Cancer Patients' Voice; and Ian E. Smith, Royal Marsden Hospital, London, United Kingdom.
J Clin Oncol. 2014 Oct 10;32(29):3307-29. doi: 10.1200/JCO.2014.56.7479. Epub 2014 Sep 2.
To identify optimal chemo- and targeted therapy for women with human epidermal growth factor 2 (HER2)- negative (or unknown) advanced breast cancer.
A systematic review of randomized evidence (including systematic reviews and meta-analyses) from 1993 through to current was completed. Outcomes of interest included survival, progression-free survival, response, quality of life, and adverse effects. Guideline recommendations were evidence based and were agreed on by the Expert Panel via consensus.
Seventy-nine studies met the inclusion criteria, comprising 20 systematic reviews and/or meta-analyses, 30 trials on first-line treatment, and 29 trials on second-line and subsequent treatment. These trials form the evidence base for the guideline recommendations.
Endocrine therapy is preferable to chemotherapy as first-line treatment for patients with estrogen receptor-positive metastatic breast cancer unless improvement is medically necessary (eg, immediately life-threatening disease). Single agent is preferable to combination chemotherapy, and longer planned duration improves outcome but must be balanced against toxicity. There is no single optimal first-line or subsequent line chemotherapy, and choice of treatment will be determined by multiple factors including prior therapy, toxicity, performance status, comorbid conditions, and patient preference. The role of bevacizumab remains controversial. Other targeted therapies have not so far been shown to enhance chemotherapy outcome in HER2-negative breast cancer.
确定针对人表皮生长因子2（HER2）阴性（或未知）晚期乳腺癌女性患者的最佳化疗和靶向治疗方案。
完成了对1993年至当前随机证据（包括系统评价和荟萃分析）的系统评价。感兴趣的结果包括生存率、无进展生存期、缓解率、生活质量和不良反应。指南建议基于证据，并由专家小组通过共识达成一致。
79项研究符合纳入标准，包括20项系统评价和/或荟萃分析、30项一线治疗试验以及29项二线及后续治疗试验。这些试验构成了指南建议的证据基础。
对于雌激素受体阳性转移性乳腺癌患者，内分泌治疗作为一线治疗优于化疗，除非出于医学必要性（如危及生命的疾病）而需要改善。单药治疗优于联合化疗，计划治疗时间延长可改善预后，但必须权衡毒性。没有单一的最佳一线或后续化疗方案，治疗选择将由多种因素决定，包括既往治疗、毒性、体能状态、合并症和患者偏好。贝伐单抗的作用仍存在争议。迄今为止，其他靶向治疗尚未显示能增强HER2阴性乳腺癌的化疗效果。
