Pan-Asian adapted ESMO Clinical Practice Guidelines for the diagnosis, treatment and follow-up of patients with early breast cancer
- Study type
- Clinical guideline
- Study name
- ESMO Pan-Asian EBC 2024
- Design
- Consensus guideline adapted from the 2023 ESMO clinical guideline for early breast cancer (Loibl et al., Ann Oncol 2024) by experts from 10 Asian oncology societies, coordinated by ESMO and KSMO; ESMO levels of evidence and grades of recommendation
- Source
- ESMO Open · 2024
In plain words
This guideline, based on the 2023 European ESMO guideline and prepared with experts from Asian countries, is a road map for treating early breast cancer: from BRCA genetic testing and genomic tests to decide on chemotherapy, to immunotherapy in triple-negative cancer and follow-on treatments after surgery chosen according to how the cancer responded to treatment.
Key guideline recommendations
- I, A
Germline testing and genetic counselling for pathogenic BRCA1/2 variants should be offered to patients who meet the relevant national criteria and to candidates for adjuvant olaparib based on the OlympiA trial.
- I, E
PD-L1 expression should not be used to guide treatment decisions in early breast cancer.
- I, B
When the indication for adjuvant chemotherapy is uncertain (after considering all clinical and pathological factors), gene expression assays and/or assessment of response to endocrine therapy can be used to guide the adjuvant chemotherapy decision.
- I, A
Abemaciclib for 2 years with endocrine therapy after completion of locoregional treatment should be considered in patients with stage III or high-risk stage II disease.
- I, A
After completion of (neo)adjuvant and locoregional treatment, one year of adjuvant olaparib is recommended for patients with a germline BRCA1/2 mutation and HR-positive/HER2-negative cancer with several positive lymph nodes after primary surgery, or high-risk residual disease after neoadjuvant chemotherapy.
- I, A
Dual HER2 blockade with trastuzumab and pertuzumab (compared with trastuzumab alone) plus chemotherapy produces higher pCR rates and is recommended for neoadjuvant treatment.
- I, A
Patients with residual invasive disease (no pCR after neoadjuvant chemotherapy and anti-HER2 therapy) should receive adjuvant T-DM1 for up to 14 cycles.
- I, A
TNBC with cT2–4 N0 or any node-positive status (stage II–III) should be treated with neoadjuvant chemotherapy plus pembrolizumab, unless there are risk factors for severe immune toxicity.
- I, A
Pembrolizumab should be given every 3 weeks throughout the neoadjuvant phase and for nine 3-weekly cycles in the adjuvant phase, regardless of pCR status.
- I, A
In patients with a germline BRCA1/2 mutation and high-risk TNBC (no pCR or pathological stage II–III), one year of adjuvant olaparib is recommended.
- I, A
Patients with residual disease who have not received an immune checkpoint inhibitor should receive adjuvant capecitabine for 6 to 8 cycles.
Study population
Patients with early breast cancer: diagnosis, pathology and biomarkers, staging, local and systemic treatment by subtype (HR-positive/HER2-negative, HER2-positive, triple-negative) and follow-up.
Clinical significance and place in guidelines
This open-access adapted version reproduces the recommendations of the 2023/2024 ESMO guideline for early breast cancer (Loibl et al., Ann Oncol 2024; DOI: 10.1016/j.annonc.2023.11.016) with the same levels of evidence. Note: NATALEE data (adjuvant ribociclib) were not included in the recommendations because regulatory approval was lacking at the time of drafting, and DESTINY-Breast05 (2026) was published afterwards.
Limitations
Some recommendations were adapted for Asian patients; newer evidence (approval of adjuvant ribociclib in 2024, DESTINY-Breast05 and the KEYNOTE-522 overall survival data) is not reflected.
This summary was prepared by the editorial team from the published paper; the original paper is the final reference. Read the original abstract on PubMed.