Table 2.
Clinical questions for EBC
| SoR | SoE | Consensus rate | ||
|---|---|---|---|---|
| CQ.1 | Is ET recommended after breast-conserving therapy for patients with HR-positive non-invasive ductal carcinoma of the breast? | |||
| Recommendation | Tamoxifen is weakly recommended regardless of menopausal status | 2 | Strong | 90% |
| AIs are weakly recommended in postmenopausal patients | 2 | Strong | 83% | |
| CQ.2 | What adjuvant ET is recommended for premenopausal patients with HR-positive EBC? | |||
| Recommendation | Tamoxifen alone is strongly recommended for patients with high-risk HR-positive EBC | 1 | Strong | 100% |
| A combination of a LH-RH agonist and tamoxifen is strongly recommended | 1 | Strong | 98% | |
| A combination of a LH-RH agonist and an AI is strongly recommended | 1 | Moderate | 85% | |
| CQ.3 | What adjuvant ET is recommended for postmenopausal patients with HR-positive EBC? | |||
| Recommendation | AI is strongly recommended | 1 | Strong | 100% |
| Tamoxifen is weakly recommended | 2 | Strong | 96% | |
| CQ.4 | Is additional ET recommended after 5 years of adjuvant ET for patients with invasive breast cancer? | |||
| Recommendation | Additional 5-year administration of tamoxifen after 5 years of tamoxifen is recommended | 1–2 | Moderate |
1: 43% 2: 57% |
| Additional 2- to 5-year administration of an AI after 5 years of ET is weakly recommended | 2 | Strong | 98% | |
| CQ.5 | Is concurrent use of S-1 with ET recommended as adjuvant therapy for patients with HR-positive, HER2-negative EBC? | |||
| Recommendation | Concurrent use of S-1 with ET for 1 year is strongly recommended for patients with a high risk of recurrence | 1 | Moderate | 72% |
| CQ.6 | Is abemaciclib combined with ET recommended as adjuvant therapy for patients with HR-positive, HER2-negative EBC? | |||
| Recommendation | Concurrent use of abemaciclib with ET for 2 years is strongly recommended for patients with a high risk of recurrence | 1 | Moderate | 75% |
| CQ.7 | Is sequential administration of anthracycline- and taxane-based chemotherapy recommended for patients with HER2-negative EBC? | |||
| Recommendation | Sequential administration of anthracycline- and taxane-based chemotherapy is strongly recommended for high-risk HER2-negative EBC | 1 | Strong | 92% |
| CQ.8 | Is TC recommended for patients with HER2-negative EBC treated with chemotherapy? | |||
| Recommendation | TC is weakly recommended | 2 | Moderate | 92% |
| CQ.9 | Is dose-dense chemotherapy recommended for patients with EBC treated with chemotherapy? | |||
| Recommendation | Dose-dense chemotherapy is strongly recommended for high-risk EBC | 1 | Strong | 72% |
| CQ.10 | Is capecitabine recommended as adjuvant chemotherapy for patients with HER2-negative EBC who did not achieve a pathologic complete response (pCR) with neoadjvuant chemotherapy? | |||
| Recommendation | Six to eight cycles of capecitabine is strongly recommended | 1 | Moderate | 77% |
| CQ.11 | Is it recommended to omit adjuvant chemotherapy for patients with HR-positive, HER2-negative EBC based on the results of a multigene assay? | |||
| Recommendation | If the RS of Oncotype DX is 25 or less, it is strongly recommended to omit adjuvant chemotherapy for patients with negative lymph nodes | 1 | Strong | 90% |
| CQ.12 | Is addition of pertuzumab to trastuzumab recommended for patients with HER2-positive EBC treated with neoadjuvant chemotherapy? | |||
| Recommendation | Addition of pertuzumab to trastuzumab is strongly recommended | 1 | Strong | 82% |
| CQ.13 | Is trastuzumab emtansine recommended as adjuvant therapy for patients with HER2-positive EBC who did not achieve pCR with neoadjuvant chemotherapy? | |||
| Recommendation | Trastuzumab emtansine 14 cycles is strongly recommended | 1 | Moderate | 87% |
| CQ.14 | Is addition of pertuzumab to trastuzumab recommended for patients with HER2-positive EBC treated with adjuvant chemotherapy? | |||
| Recommendation | Addition of pertuzumab to trastuzumab is strongly recommended for patients with high-risk HER2-positive breast cancer | 1 | Strong | 89% |
| CQ.15 | Is trastuzumab monotherapy recommended as adjuvant therapy for elderly patients with HER2-positive EBC? | |||
| Recommendation | Trastuzumab monotherapy is weakly recommended for elderly patients who have difficulty receiving chemotherapy | 2 | Weak | 98% |
| CQ.16 | Is an immune checkpoint inhibitor recommended as neoadjuvant/adjuvant therapy for patients with triple-negative EBC? | |||
| Recommendation | Pembrolizumab (an anti-PD-1 antibody) is weakly recommended | 2 | Moderate | 80% |
| CQ.17 | Is platinum-based chemotherapy recommended for patients with triple-negative EBC? | |||
| Recommendation | Platinum-based chemotherapy is strongly recommended, | 1 | Strong | 70% |
| CQ.33 (former FRQ.5) | Are polyADP-ribose polymerase (PARP) inhibitors recommended as adjuvant therapy for patients with germline BRCA1/2 pathogenic variant-positive EBC? | |||
| Recommendation | Olaparib for 1 year after perioperative chemotherapy is strongly recommended for patients with HER2-negative EBC and a high risk of recurrence | 1 | Moderate | 90% |