Neelima Denduluri, MD
Patients with early-stage breast cancer facing a high risk of recurrence would benefit from the expanded use of adjuvant therapy, according to updated guidelines from the American Society of Clinical Oncology (ASCO). The recommendations cover clinical scenarios for patients with residual invasive HER2-negative disease after surgery and those with HER2-positive tumors who are candidates for additional targeted therapy (Table
• Should patients with early-stage HER2-positive breast cancer receive extended adjuvant therapy with neratinib (Nerlynx) following combination chemotherapy and trastuzumab-based adjuvant therapy?
Capecitabine in HER2-Negative Disease
ASCO offered a moderate recommendation based on “intermediate” evidence in favor of adding adjuvant capecitabine following standard anthracycline- and taxane-based preoperative therapy for patients with early-stage HER2-negative breast cancer who have pathologic invasive residual disease at surgery (Figure
The update also addresses women with HER2-negative disease who have residual cancer burden at the time of surgery despite receiving preoperative therapy. Those women are at increased risk for relapse, but data from the CREATE-X trial suggest that these patients derive benefit from the addition of adjuvant capecitabine. The panel concluded that adjuvant capecitabine was likely to benefit patients with triple-negative disease as well.
Table. Updated ASCO Recommendations for Early-Stage Breast Cancer
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