Evidence-based recommendations have been developed for chemotherapy and targeted therapy for women with human epidermal growth factor receptor 2 (HER2)-negative advanced breast cancer. The clinical practice guideline was published online in the Journal of Clinical Oncology.

Ann H. Partridge, M.D., M.P.H., from the Dana-Farber Cancer Institute in Boston, and colleagues conducted a systematic review of the randomized evidence from 1993 to identify chemotherapy and targeted therapy for women with HER2-negative (or unknown) advanced breast cancer. Evidence from 79 studies was included in the guideline recommendations.

The researchers note that for patients with estrogen receptor-positive metastatic breast cancer, endocrine therapy is preferable to chemotherapy unless improvement is medically necessary. Single agent is preferable to combination therapy, and the improved outcome of longer planned duration must be balanced against toxicity.

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No single optimal first-line or subsequent-line chemotherapy exists, with multiple factors, including prior therapy, toxicity, performance status, comorbidity, and patient preference, influencing the choice of treatment. The role of bevacizumab is controversial and other targeted therapies have not been shown to enhance chemotherapy outcome.

“The treatment of advanced breast cancer is an area of intense research, and data are evolving quite rapidly, which means that any recommendations are likely to change,” the authors write.

  1. Partridge, Ann H., et al. “Chemotherapy and Targeted Therapy for Women With Human Epidermal Growth Factor Receptor 2-Negative (or unknown) Advanced Breast cancer: American Society of Clinical Oncology Clinical Practice Guideline.” The Journal of Clinical Oncology. doi: 10.1200/JCO.2014.56.7479. September 2, 2014.