{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T12:59:56Z","timestamp":1793105996542,"version":"4.5.0"},"reference-count":49,"publisher":"American Society of Clinical Oncology (ASCO)","issue":"23","content-domain":{"domain":["ascopubs.org"],"crossmark-restriction":true},"short-container-title":["JCO"],"published-print":{"date-parts":[[2022,8,10]]},"abstract":"<jats:sec>\n                    <jats:title>PURPOSE<\/jats:title>\n                    <jats:p>To update evidence-based guideline recommendations to practicing oncologists and others on systemic therapy for patients with human epidermal growth factor receptor 2 (HER2)\u2013positive advanced breast cancer.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>An Expert Panel conducted a targeted systematic literature review (for both systemic treatment and CNS metastases) and identified 545 articles. Outcomes of interest included efficacy and safety.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Of the 545 publications identified and reviewed, 14 were identified to form the evidentiary basis for the guideline recommendations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RECOMMENDATIONS<\/jats:title>\n                    <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 deruxtecan for second-line treatment are recommended. In the third-line setting, clinicians should offer other HER2-targeted therapy combinations. There is a lack of head-to-head trials; therefore, there is insufficient evidence to recommend one regimen over another. The patient and the clinician should discuss differences in treatment schedule, route, toxicities, etc during the decision-making process. Options include regimens with tucatinib, trastuzumab emtansine, trastuzumab deruxtecan (if either not previously administered), neratinib, lapatinib, chemotherapy, margetuximab, hormonal therapy, and abemaciclib plus trastuzumab plus fulvestrant, and may offer pertuzumab if the patient has not previously received it. Optimal duration of chemotherapy is at least 4-6 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 or 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>\n                  <\/jats:sec>","DOI":"10.1200\/jco.22.00519","type":"journal-article","created":{"date-parts":[[2022,5,31]],"date-time":"2022-05-31T15:59:21Z","timestamp":1654012761000},"page":"2612-2635","update-policy":"https:\/\/doi.org\/10.1200\/crossmark","source":"Crossref","is-referenced-by-count":175,"title":["Systemic Therapy for Advanced Human Epidermal Growth Factor Receptor 2\u2013Positive Breast Cancer: ASCO Guideline Update"],"prefix":"10.1200","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8700-2767","authenticated-orcid":false,"given":"Sharon H.","family":"Giordano","sequence":"first","affiliation":[{"name":"University of Texas MD Anderson, Houston, TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2470-6054","authenticated-orcid":false,"given":"Maria Alice B.","family":"Franzoi","sequence":"additional","affiliation":[{"name":"Institute Gustave Roussy, Villejuif, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1834-0551","authenticated-orcid":false,"given":"Sarah","family":"Temin","sequence":"additional","affiliation":[{"name":"American Society of Clinical Oncology, Alexandria, VA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carey K.","family":"Anders","sequence":"additional","affiliation":[{"name":"Duke University, Durham, NC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4532-8053","authenticated-orcid":false,"given":"Sarat","family":"Chandarlapaty","sequence":"additional","affiliation":[{"name":"Memorial Sloan Kettering Cancer Center, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennie R.","family":"Crews","sequence":"additional","affiliation":[{"name":"Seattle Cancer Care Alliance, Seattle, WA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey J.","family":"Kirshner","sequence":"additional","affiliation":[{"name":"Hematology\/Oncology Associates of Central New York, East Syracuse, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6380-5944","authenticated-orcid":false,"given":"Ian E.","family":"Krop","sequence":"additional","affiliation":[{"name":"Dana-Farber Cancer Institute, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2263-5413","authenticated-orcid":false,"given":"Nancy U.","family":"Lin","sequence":"additional","affiliation":[{"name":"Dana-Farber Cancer Institute, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4764-4896","authenticated-orcid":false,"given":"Aki","family":"Morikawa","sequence":"additional","affiliation":[{"name":"University of Michigan, Ann Arbor, MI"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5185-5170","authenticated-orcid":false,"given":"Debra A.","family":"Patt","sequence":"additional","affiliation":[{"name":"Texas Oncology, Austin, TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jane","family":"Perlmutter","sequence":"additional","affiliation":[{"name":"Patient Advocate, Ann Arbor, MI"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7544-7083","authenticated-orcid":false,"given":"Naren","family":"Ramakrishna","sequence":"additional","affiliation":[{"name":"University of Florida Health Cancer Center at Orlando Health, Orlando, FL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nancy E.","family":"Davidson","sequence":"additional","affiliation":[{"name":"Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"233","reference":[{"key":"b1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2018.79.2697"},{"key":"b2","doi-asserted-by":"publisher","DOI":"10.1136\/amiajnl-2011-000172"},{"key":"b3","first-page":"ED000142","volume":"10","author":"Cumpston M","year":"2019","journal-title":"Cochrane Database Syst Rev"},{"key":"b4","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2010.07.015"},{"key":"b5","doi-asserted-by":"publisher","DOI":"10.4103\/ijc.IJC_449_17"},{"key":"b6","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoncol.2016.0237"},{"key":"b7","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(19)30863-0"},{"key":"b8","doi-asserted-by":"publisher","DOI":"10.1038\/s41416-018-0340-2"},{"key":"b9","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2016.18305"},{"key":"b10","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(20)30465-4"},{"key":"b11","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2016.70.6267"},{"key":"b12","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(17)30312-1"},{"key":"b13","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(17)30313-3"},{"key":"b14","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.20.00147"},{"key":"b15","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1914609"},{"key":"b16","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(20)30112-1"},{"key":"b17","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1914510"},{"key":"b18","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2115022"},{"key":"b19","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoncol.2020.7932"},{"key":"b20","doi-asserted-by":"publisher","DOI":"10.1093\/annonc\/mdz061"},{"key":"b21","doi-asserted-by":"publisher","DOI":"10.1093\/annonc\/mdw622"},{"key":"b22","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.32392"},{"key":"b23","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(20)30702-6"},{"key":"b24","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejca.2018.12.022"},{"key":"b25","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.20.00775"},{"key":"b26","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2013.54.0948"},{"key":"b27","doi-asserted-by":"crossref","first-page":"2636","DOI":"10.1200\/JCO.2022.40.16_suppl.2636","volume":"40","author":"Ramakrishna N","year":"2022","journal-title":"J Clin Oncol"},{"key":"b28","volume":"80","author":"Cort\u00e9s J","year":"2020","journal-title":"Cancer Res"},{"key":"b29","doi-asserted-by":"publisher","DOI":"10.1200\/OP.21.00771"},{"key":"b30","volume-title":"Biosimilar product information","author":"FDA","year":"2021"},{"key":"b31","doi-asserted-by":"publisher","DOI":"10.1177\/1758835918818335"},{"key":"b32","volume-title":"State laws and legislation related to biologic medications and substitution of biosimilars. National Conference of State Legislatures, May 3, 2019","author":"Cauchi R"},{"key":"b33","doi-asserted-by":"publisher","DOI":"10.1016\/j.clbc.2019.02.008"},{"key":"b34","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(20)30536-2"},{"key":"b35","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2017.75.2311"},{"key":"b36","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.20.00642"},{"key":"b37","volume-title":"SEER Cancer Statistics Review, 1975-2013","author":"Howlader N","year":"2016"},{"key":"b38","volume-title":"Cancer Facts & Figures for African Americans 2019-2021","author":"American Cancer Society","year":"2019"},{"key":"b39","volume-title":"United States Cancer Statistics: 1999\u20132012 Incidence and Mortality Web-Based Report","author":"United States Cancer Statistics Working Group","year":"2015"},{"key":"b40","volume-title":"Racial and Ethnic Disparities in U.S. Health Care: A Chartbook","author":"Mead H","year":"2008"},{"key":"b41","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2015.61.6706"},{"key":"b42","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2016.68.2518"},{"key":"b43","doi-asserted-by":"publisher","DOI":"10.1200\/JOP.2011.000316"},{"key":"b44","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2013.52.9123"},{"key":"b45","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2009.23.1183"},{"key":"b46","first-page":"1","author":"Fryar CD","year":"2021","journal-title":"Vital Health Stat 3"},{"key":"b49","doi-asserted-by":"publisher","DOI":"10.6004\/jnccn.2019.7373"},{"key":"b50","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2016.70.1474"},{"key":"b51","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2018.77.8738"}],"container-title":["Journal of Clinical Oncology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/ascopubs.org\/doi\/pdfdirect\/10.1200\/JCO.22.00519","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,8,5]],"date-time":"2022-08-05T18:00:19Z","timestamp":1659722419000},"score":1,"resource":{"primary":{"URL":"https:\/\/ascopubs.org\/doi\/10.1200\/JCO.22.00519"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,8,10]]},"references-count":49,"journal-issue":{"issue":"23","published-print":{"date-parts":[[2022,8,10]]}},"alternative-id":["10.1200\/JCO.22.00519"],"URL":"https:\/\/doi.org\/10.1200\/jco.22.00519","relation":{},"ISSN":["0732-183X","1527-7755"],"issn-type":[{"value":"0732-183X","type":"print"},{"value":"1527-7755","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,8,10]]},"assertion":[{"value":"2022-03-02","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-04-05","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-05-31","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}