{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T17:21:58Z","timestamp":1790788918435,"version":"4.1.0"},"reference-count":6,"publisher":"American Society of Clinical Oncology (ASCO)","issue":"26","content-domain":{"domain":["ascopubs.org"],"crossmark-restriction":true},"short-container-title":["JCO"],"published-print":{"date-parts":[[2018,9,10]]},"abstract":"<jats:sec><jats:title>Purpose<\/jats:title><jats:p> To update evidence-based guideline recommendations for practicing oncologists and others on systemic therapy for patients with human epidermal growth factor receptor 2 (HER2)\u2013positive advanced breast cancer to 2018. <\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p> An Expert Panel conducted a targeted systematic literature review (for both systemic treatment and CNS metastases) and identified 622 articles. Outcomes of interest included overall survival, progression-free survival, and adverse events. <\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p> Of the 622 publications identified and reviewed, no additional evidence was identified that would warrant a change to the 2014 recommendations. <\/jats:p><\/jats:sec><jats:sec><jats:title>Recommendations<\/jats:title><jats:p> HER2-targeted therapy is recommended for patients with HER2-positive advanced breast cancer, except for those with clinical congestive heart failure or significantly compromised left ventricular ejection fraction, who should be evaluated on a case-by-case basis. Trastuzumab, pertuzumab, and taxane for first-line treatment and trastuzumab emtansine for second-line treatment are recommended. In the third-line setting, clinicians should offer other HER2-targeted therapy combinations or trastuzumab emtansine (if not previously administered) and may offer pertuzumab if the patient has not previously received it. Optimal duration of chemotherapy is at least 4 to 6 months or until maximum response, depending on toxicity and in the absence of progression. HER2-targeted therapy can continue until time of progression or unacceptable toxicities. For patients with HER2-positive and estrogen receptor\u2013positive\/progesterone receptor\u2013positive breast cancer, clinicians may recommend either standard first-line therapy or, for selected patients, endocrine therapy plus HER2-targeted therapy or endocrine therapy alone. Additional information is available at www.asco.org\/breast-cancer-guidelines . <\/jats:p><\/jats:sec>","DOI":"10.1200\/jco.2018.79.2697","type":"journal-article","created":{"date-parts":[[2018,6,25]],"date-time":"2018-06-25T20:00:33Z","timestamp":1529956833000},"page":"2736-2740","update-policy":"https:\/\/doi.org\/10.1200\/crossmark","source":"Crossref","is-referenced-by-count":154,"title":["Systemic Therapy for Patients With Advanced Human Epidermal Growth Factor Receptor 2\u2013Positive Breast Cancer: ASCO Clinical Practice Guideline Update"],"prefix":"10.1200","volume":"36","author":[{"given":"Sharon H.","family":"Giordano","sequence":"first","affiliation":[{"name":"Sharon H. Giordano, The University of Texas MD Anderson, Houston; Debra A. Patt, Texas Oncology, Austin, TX; Sarah Temin, American Society of Clinical Oncology, Alexandria, VA; Sarat Chandarlapaty and Shanu Modi, Memorial Sloan Kettering Cancer Center; Francisco J. Esteva, New York University Langone Medical Center, New York; Jeffrey J. Kirshner, Hematology\/Oncology Associates of Central New York, East Syracuse, NY; Jennie R. Crews, Seattle Cancer Care Alliance; Nancy E. Davidson, Fred Hutchinson Cancer..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Temin","sequence":"additional","affiliation":[{"name":"Sharon H. Giordano, The University of Texas MD Anderson, Houston; Debra A. Patt, Texas Oncology, Austin, TX; Sarah Temin, American Society of Clinical Oncology, Alexandria, VA; Sarat Chandarlapaty and Shanu Modi, Memorial Sloan Kettering Cancer Center; Francisco J. Esteva, New York University Langone Medical Center, New York; Jeffrey J. Kirshner, Hematology\/Oncology Associates of Central New York, East Syracuse, NY; Jennie R. Crews, Seattle Cancer Care Alliance; Nancy E. Davidson, Fred Hutchinson Cancer..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarat","family":"Chandarlapaty","sequence":"additional","affiliation":[{"name":"Sharon H. Giordano, The University of Texas MD Anderson, Houston; Debra A. Patt, Texas Oncology, Austin, TX; Sarah Temin, American Society of Clinical Oncology, Alexandria, VA; Sarat Chandarlapaty and Shanu Modi, Memorial Sloan Kettering Cancer Center; Francisco J. Esteva, New York University Langone Medical Center, New York; Jeffrey J. Kirshner, Hematology\/Oncology Associates of Central New York, East Syracuse, NY; Jennie R. Crews, Seattle Cancer Care Alliance; Nancy E. Davidson, Fred Hutchinson Cancer..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennie R.","family":"Crews","sequence":"additional","affiliation":[{"name":"Sharon H. Giordano, The University of Texas MD Anderson, Houston; Debra A. Patt, Texas Oncology, Austin, TX; Sarah Temin, American Society of Clinical Oncology, Alexandria, VA; Sarat Chandarlapaty and Shanu Modi, Memorial Sloan Kettering Cancer Center; Francisco J. Esteva, New York University Langone Medical Center, New York; Jeffrey J. Kirshner, Hematology\/Oncology Associates of Central New York, East Syracuse, NY; Jennie R. Crews, Seattle Cancer Care Alliance; Nancy E. Davidson, Fred Hutchinson Cancer..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francisco J.","family":"Esteva","sequence":"additional","affiliation":[{"name":"Sharon H. Giordano, The University of Texas MD Anderson, Houston; Debra A. Patt, Texas Oncology, Austin, TX; Sarah Temin, American Society of Clinical Oncology, Alexandria, VA; Sarat Chandarlapaty and Shanu Modi, Memorial Sloan Kettering Cancer Center; Francisco J. Esteva, New York University Langone Medical Center, New York; Jeffrey J. 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Giordano, The University of Texas MD Anderson, Houston; Debra A. Patt, Texas Oncology, Austin, TX; Sarah Temin, American Society of Clinical Oncology, Alexandria, VA; Sarat Chandarlapaty and Shanu Modi, Memorial Sloan Kettering Cancer Center; Francisco J. Esteva, New York University Langone Medical Center, New York; Jeffrey J. Kirshner, Hematology\/Oncology Associates of Central New York, East Syracuse, NY; Jennie R. Crews, Seattle Cancer Care Alliance; Nancy E. Davidson, Fred Hutchinson Cancer..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Levinson","sequence":"additional","affiliation":[{"name":"Sharon H. Giordano, The University of Texas MD Anderson, Houston; Debra A. Patt, Texas Oncology, Austin, TX; Sarah Temin, American Society of Clinical Oncology, Alexandria, VA; Sarat Chandarlapaty and Shanu Modi, Memorial Sloan Kettering Cancer Center; Francisco J. Esteva, New York University Langone Medical Center, New York; Jeffrey J. 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