PDF(Pubmed)
Abstract：
To guide clinicians and policymakers in three global resource-constrained settings on treating patients with metastatic breast cancer (MBC) when Maximal setting-guideline recommended treatment is unavailable.
A multidisciplinary, multinational panel reviewed existing ASCO guidelines and conducted modified ADAPTE and formal consensus processes.
Four published resource-agnostic guidelines were adapted for resource-constrained settings; informing two rounds of formal consensus; recommendations received ≥75% agreement.
Clinicians should recommend treatment according to menopausal status, pathological and biomarker features when quality results are available. In first-line, for hormone receptor (HR)-positive MBC, when a non-steroidal aromatase inhibitor and CDK 4/6 inhibitor combination is unavailable, use hormonal therapy alone. For life-threatening disease, use single-agent chemotherapy or surgery for local control. For premenopausal patients, use ovarian suppression or ablation plus hormone therapy in Basic settings. For human epidermal growth factor receptor 2 (HER2)-positive MBC, if trastuzumab, pertuzumab, and chemotherapy are unavailable, use trastuzumab and chemotherapy; if unavailable, use chemotherapy. For HER2-positive, HR-positive MBC, use standard first-line therapy, or endocrine therapy if contraindications. For triple-negative MBC with unknown PD-L1 status, or if PD-L1-positive and immunotherapy unavailable, use single-agent chemotherapy. For germline BRCA1/2 mutation-positive MBC, if poly(ADP-ribose) polymerase inhibitor is unavailable, use hormonal therapy (HR-positive MBC) and chemotherapy (HR-negative MBC). In second-line, for HR-positive MBC, Enhanced setting recommendations depend on prior treatment; for Limited, use tamoxifen or chemotherapy. For HER2-positive MBC, if trastuzumab deruxtecan is unavailable, use trastuzumab emtansine; if unavailable, capecitabine and lapatinib; if unavailable, trastuzumab and/or chemotherapy (hormonal therapy alone for HR-positive MBC).Additional information is available at www.asco.org/resource-stratified-guidelines. It is ASCO\'s view that healthcare providers and system decision-makers should be guided by the recommendations for the highest stratum of resources available. The guideline is intended to complement but not replace local guidelines.
A multidisciplinary, multinational panel reviewed existing ASCO guidelines and conducted modified ADAPTE and formal consensus processes.
Four published resource-agnostic guidelines were adapted for resource-constrained settings; informing two rounds of formal consensus; recommendations received ≥75% agreement.
Clinicians should recommend treatment according to menopausal status, pathological and biomarker features when quality results are available. In first-line, for hormone receptor (HR)-positive MBC, when a non-steroidal aromatase inhibitor and CDK 4/6 inhibitor combination is unavailable, use hormonal therapy alone. For life-threatening disease, use single-agent chemotherapy or surgery for local control. For premenopausal patients, use ovarian suppression or ablation plus hormone therapy in Basic settings. For human epidermal growth factor receptor 2 (HER2)-positive MBC, if trastuzumab, pertuzumab, and chemotherapy are unavailable, use trastuzumab and chemotherapy; if unavailable, use chemotherapy. For HER2-positive, HR-positive MBC, use standard first-line therapy, or endocrine therapy if contraindications. For triple-negative MBC with unknown PD-L1 status, or if PD-L1-positive and immunotherapy unavailable, use single-agent chemotherapy. For germline BRCA1/2 mutation-positive MBC, if poly(ADP-ribose) polymerase inhibitor is unavailable, use hormonal therapy (HR-positive MBC) and chemotherapy (HR-negative MBC). In second-line, for HR-positive MBC, Enhanced setting recommendations depend on prior treatment; for Limited, use tamoxifen or chemotherapy. For HER2-positive MBC, if trastuzumab deruxtecan is unavailable, use trastuzumab emtansine; if unavailable, capecitabine and lapatinib; if unavailable, trastuzumab and/or chemotherapy (hormonal therapy alone for HR-positive MBC).Additional information is available at www.asco.org/resource-stratified-guidelines. It is ASCO\'s view that healthcare providers and system decision-makers should be guided by the recommendations for the highest stratum of resources available. The guideline is intended to complement but not replace local guidelines.
摘要：
目的：在无法获得最大设置指南推荐治疗的情况下，在三个全球资源有限的环境中指导临床医生和政策制定者治疗转移性乳腺癌（MBC）患者。
方法：多学科，跨国小组审查了现有的ASCO指南，并进行了修改的ADAPTE和正式共识程序。
结果：四个已发布的资源不可知指南适用于资源受限的环境；通知两轮正式共识；建议获得≥75％的同意。
结论：临床医生应根据绝经情况推荐治疗，当质量结果可用时，病理和生物标志物特征。在第一线,激素受体（HR）阳性MBC，当非甾体芳香化酶抑制剂和CDK4/6抑制剂组合不可用时，单独使用激素治疗。对于危及生命的疾病，使用单药化疗或手术进行局部控制。对于绝经前的患者，在基础环境中使用卵巢抑制或消融加激素治疗。对于人类表皮生长因子受体2（HER2）阳性MBC，如果曲妥珠单抗，帕妥珠单抗,无法进行化疗，使用曲妥珠单抗和化疗；如果没有，使用化疗。对于HER2阳性，HR阳性MBC,使用标准的一线治疗，或内分泌治疗，如果禁忌症。对于PD-L1状态未知的三阴性MBC，或者如果PD-L1阳性和免疫疗法不可用，使用单药化疗。对于种系BRCA1/2突变阳性MBC，如果聚（ADP-核糖）聚合酶抑制剂不可用，使用激素治疗（HR阳性MBC）和化疗（HR阴性MBC）。在第二行，对于HR阳性MBC，强化设置建议取决于先前的治疗；对于Limited，使用他莫昔芬或化疗。对于HER2阳性MBC，如果曲妥珠单抗deruxtecan不可用，使用曲妥珠单抗emtansine；如果不可用，卡培他滨和拉帕替尼；如果没有，曲妥珠单抗和/或化疗（激素治疗HR阳性MBC）。其他信息可在www上获得。asco.org/resource-stratified-guidelines.ASCO认为，医疗保健提供者和系统决策者应该以最高可用资源层的建议为指导。该指南旨在补充而不是取代当地指南。
方法：多学科，跨国小组审查了现有的ASCO指南，并进行了修改的ADAPTE和正式共识程序。
结果：四个已发布的资源不可知指南适用于资源受限的环境；通知两轮正式共识；建议获得≥75％的同意。
结论：临床医生应根据绝经情况推荐治疗，当质量结果可用时，病理和生物标志物特征。在第一线,激素受体（HR）阳性MBC，当非甾体芳香化酶抑制剂和CDK4/6抑制剂组合不可用时，单独使用激素治疗。对于危及生命的疾病，使用单药化疗或手术进行局部控制。对于绝经前的患者，在基础环境中使用卵巢抑制或消融加激素治疗。对于人类表皮生长因子受体2（HER2）阳性MBC，如果曲妥珠单抗，帕妥珠单抗,无法进行化疗，使用曲妥珠单抗和化疗；如果没有，使用化疗。对于HER2阳性，HR阳性MBC,使用标准的一线治疗，或内分泌治疗，如果禁忌症。对于PD-L1状态未知的三阴性MBC，或者如果PD-L1阳性和免疫疗法不可用，使用单药化疗。对于种系BRCA1/2突变阳性MBC，如果聚（ADP-核糖）聚合酶抑制剂不可用，使用激素治疗（HR阳性MBC）和化疗（HR阴性MBC）。在第二行，对于HR阳性MBC，强化设置建议取决于先前的治疗；对于Limited，使用他莫昔芬或化疗。对于HER2阳性MBC，如果曲妥珠单抗deruxtecan不可用，使用曲妥珠单抗emtansine；如果不可用，卡培他滨和拉帕替尼；如果没有，曲妥珠单抗和/或化疗（激素治疗HR阳性MBC）。其他信息可在www上获得。asco.org/resource-stratified-guidelines.ASCO认为，医疗保健提供者和系统决策者应该以最高可用资源层的建议为指导。该指南旨在补充而不是取代当地指南。
