Adjuvant Endocrine Therapy for Women With Hormone Receptor–Positive Breast Cancer
Guideline Status: Current
Published Online: December 5, 2018
Last Updated: July 18, 2023
Published before print, December 5, 2018. DOI: 10.1200/JOP.18.00617
Harold J. Burstein, Christina Lacchetti, and Jennifer J. Griggs.
Purpose
ASCO has produced a 2018 focused update in response to new peer-reviewed publications of six randomized clinical trials on extending aromatase inhibitor treatment published since the literature search date cutoff for the 2014 update.
Methods
An Expert Panel was convened to update clinical practice guideline recommendations based on a systematic review of the medical literature.
Focused Update Recommendations
Recommendation 1. Many women with node-negative breast cancer are potential candidates for and may be offered extended therapy for up to a total of 10 years of adjuvant endocrine treatment, based on considerations of recurrence risk using established prognostic factors. However, because the recurrence risk is lower, the benefits are likely narrower for such patients. Women with low-risk node-negative tumors should not routinely be offered extended therapy.
Recommendation 2. Women with node-positive breast cancer should be offered extended AI therapy for up to a total of 10 years of adjuvant endocrine treatment.
Recommendation 3. Women receiving extended adjuvant endocrine therapy should receive no more than 10 years of total treatment.
Recommendation 4. As prevention of secondary or contralateral breast cancers is a major benefit of extended AI therapy, the risk of second breast cancers (or not) based on prior therapy should inform the decision to pursue extended treatment.
Recommendation 5. Extended therapy carries ongoing risks and side effects, which should be weighed against the potential absolute benefits of longer treatment, in a shared decision-making process between the clinical team and the patient.
Qualifying Statement. To date, none of the studies has shown improvement in overall survival with longerduration AI therapy. As such, the recommendations on extended adjuvant AI therapy are ba
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