1 Dana-Farber Cancer Institute, Boston, MA.
2 American Society of Clinical Oncology, Alexandria, VA.
J Clin Oncol. 2019 Feb 10;37(5):423-438. doi: 10.1200/JCO.18.01160. Epub 2018 Nov 19.
To update the ASCO clinical practice guideline on adjuvant endocrine therapy based on emerging data about the optimal duration of aromatase inhibitor (AI) treatment.
ASCO conducted a systematic review of randomized clinical trials from 2012 to 2018. Guideline recommendations were based on the Panel's review of the evidence from six trials.
The six included studies of AI treatment beyond 5 years of therapy demonstrated that extension of AI treatment was not associated with an overall survival advantage but was significantly associated with lower risks of breast cancer recurrence and contralateral breast cancer compared with placebo. Bone-related toxic effects were more common with extended AI treatment.
The Panel recommends that women with node-positive breast cancer receive extended therapy, including an AI, for up to a total of 10 years of adjuvant endocrine treatment. Many women with node-negative breast cancer should consider extended therapy for up to a total of 10 years of adjuvant endocrine treatment based on considerations of recurrence risk using established prognostic factors. The Panel noted that the benefits in absolute risk of reduction were modest and that, for lower-risk node-negative or limited node-positive cancers, an individualized approach to treatment duration that is based on considerations of risk reduction and tolerability was appropriate. A substantial portion of the benefit for extended adjuvant AI therapy was derived from prevention of second breast cancers. Shared decision making between clinicians and patients is appropriate for decisions about extended adjuvant endocrine treatment, including discussions about the absolute benefits in the reduction of breast cancer recurrence, the prevention of second breast cancers, and the impact of adverse effects of treatment. Additional information can be found at www.asco.org/breast-cancer-guidelines .
根据关于芳香化酶抑制剂（AI）治疗最佳持续时间的新数据，更新 ASCO 关于辅助内分泌治疗的临床实践指南。
ASCO 对 2012 年至 2018 年的随机临床试验进行了系统回顾。指南建议是基于专家组对六项试验证据的审查。
六项 AI 治疗超过 5 年的研究表明，延长 AI 治疗与总体生存优势无关，但与安慰剂相比，显著降低了乳腺癌复发和对侧乳腺癌的风险。延长 AI 治疗与骨骼相关的毒性作用更为常见。
专家组建议淋巴结阳性乳腺癌患者接受延长治疗，包括 AI，辅助内分泌治疗总时长可达 10 年。许多淋巴结阴性乳腺癌患者应考虑延长治疗，总时长可达 10 年，这取决于使用既定预后因素考虑复发风险。专家组注意到，绝对风险降低的获益幅度较小，对于低风险的淋巴结阴性或有限的淋巴结阳性癌症，基于降低风险和耐受性考虑的治疗持续时间的个体化方法是合适的。延长辅助 AI 治疗的大部分获益来自于预防第二乳腺癌。延长辅助内分泌治疗的决策应由临床医生和患者共同做出，包括讨论降低乳腺癌复发、预防第二乳腺癌以及治疗不良反应影响的绝对获益。更多信息可在 www.asco.org/breast-cancer-guidelines 上找到。
