ASCO Issues Guideline for Metastatic HER2-negative Breast Cancer

Breast Cancer News
October 28, 2014
Robin Warshaw, Contributing Writer
Reviewed By: 
Harold J. Burstein, MD, PhD

The American Society of Clinical Oncology, ASCO, released a new treatment guideline for HER2-negative breast cancer that has spread from the breast to nearby areas or distant parts of the body.

The panel of experts that developed the guideline determined several less intense treatments can help with advanced or metastatic HER2-negative breast cancer.


The human epidermal growth factor 2, HER2, protein is found on breast cells. Because HER2-negative breast cancer does not have too many HER2 proteins, treatment targeted at HER2, such as trastuzumab, will not control it. According to ASCO, nearly 80 percent of women with advanced or metastatic breast cancer have HER2-negative disease.

Hormone receptors are also proteins found in cells. HER2-negative breast cancer may be hormone receptor-positive or -negative. Hormone receptor-positive breast cancer, HR-positive, is treated with hormonal medicines, such as tamoxifen or aromatase inhibitors.

ASCO guidelines are created to give doctors and those diagnosed with cancer recommendations based on scientific evidence.

Why and How the Guideline Was Created

Guideline panel members included medical oncologists, people diagnosed with breast cancer and other experts. They wanted to evaluate recent research and make recommendations to improve treatment and quality of life for women with HER2-negative breast cancer.

The panel reviewed 79 randomized studies, reviews and clinical trials carried out from 1993 to 2013. All were on treatments for advanced or metastatic HER2-negative disease. The team considered overall survival, length of survival without disease progression, response to treatment, side effects and quality of life factors.


The new guideline contains several key treatment recommendations.

  • In women with HR-positive disease, hormonal therapy should be offered as the standard first treatment because it provides better quality of life than chemotherapy.
    • Chemotherapy may be used for urgent treatment and for women with HR-negative breast cancer.
  • Chemotherapy with a single medicine is recommended over a combination of medicines, to lessen difficult side effects. Medicine changes, if needed, should be made one after another.
    • No one chemotherapy is suggested, but taxanes and anthracyclines showed the strongest results as first treatment.
  • Chemotherapy should continue when possible because it improves overall survival to a degree and substantially improves progression-free survival.
    • Second and later therapy may be beneficial and should be offered based on past treatments, possible side effects and other factors.
  • Palliative care to provide physical and emotional support and improve quality of life should be offered throughout all treatment.
  • Participation in clinical trials is encouraged.

What This Means for You

By issuing this guideline, ASCO emphasizes good treatment options for advanced or metastatic HER2-negative breast cancer. Your therapy should be based on your past treatments, side effects, medical conditions and your preferences. You and your doctor should make decisions together about your care plan.

Talk with your health care provider about how this guideline fits your current or planned therapy. Ask about clinical trials. Clinical trials can benefit you and may be convenient to where you live or work.

Side effects, feelings and emotions are important to your overall well-being. This guideline urges health care providers to offer supportive care, regardless of treatment. You may also want to watch this video of women diagnosed with metastatic disease or talk with a peer counselor on the LBBC Helpline.

Partridge, AH, Rumble, RB, Carey, LA et al. Chemotherapy and Targeted Therapy for Women With Human Epidermal Growth Factor Receptor 2-Negative (or unknown) Advanced Breast Cancer: American Society of Clinical Oncology Clinical Practice GuidelineJournal of Clinical Oncology, 2014; DOI: 10.1200/JCO.2014.56.7479. 

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