Image
Recommendation
Adjuvant endocrine therapy – Indications #1
Adjuvant endocrine therapy should be considered in all patients with ER-positive cancer, defined as ER immunohistochemistry (IHC) staining ≥1%. Discuss the benefits and risks of endocrine therapy with patients whose cancers contain low levels of ER-positive cells (1%-10% weakly positive cells by IHC).
Adjuvant endocrine therapy should be considered in all patients with ER+ cancer, defined by the ASCO/CAP guidelines as ER immunohistochemistry (IHC) staining ≥1%, taking into consideration overall disease risk, patient preference, and potential adverse effects
Clinicians should be aware of and able to discuss with patients the limited data on ER Low Positive cases and issues with test results that are close to a positive threshold
There is high confidence that the recommendation reflects best practice. This is based on (1) strong evidence for a true net effect (eg. benefits exceed harms); (2) consistent results, with no or minor exceptions; (3) minor or no concerns about study quality; and/or (4) the extent of panellists’ agreement. Other compelling considerations (discussed in the guideline’s literature review and analyses) may also warrant a strong recommendation
How this guidance was developed
This recommendation was adapted from the CCO 2014 guidelines (Canada). The source recommendation was based on a systematic review of the evidence conducted to March 2012 and was not graded by the source guideline authors. The source recommendation was adapted by removing the phrase ‘taking into consideration overall disease risk, patient preference and potential adverse effects’. The recommendation was further adapted by adding in the discussions of benefits and risks of endocrine therapy with patients whose cancers contain low levels of ER-positive cells based on the ASCO/CAP guideline update on oestrogen and progesterone receptor testing in breast cancer in 2020, which was based on a systematic review of the evidence to April 2019. The evidence quality was high, and the recommendation was graded ‘strong’ (using ASCO methods). The ASCO/CAP Expert Panel noted that there are limited data on endocrine therapy benefit for cancers with 1% to 10% of cells staining ER positive.
Adjuvant endocrine therapy – Indications #1
Recommendation
Adjuvant endocrine therapy should be considered in all patients with ER-positive cancer, defined as ER immunohistochemistry (IHC) staining ≥1%. Discuss the benefits and risks of endocrine therapy with patients whose cancers contain low levels of ER-positive cells (1%-10% weakly positive cells by IHC).
Principles in action
Patient-centred care
Image
Safe and quality care
Image
Communication
This recommendation was adapted from the CCO 2014 guidelines (Canada). The source recommendation was based on a systematic review of the evidence conducted to March 2012 and was not graded by the source guideline authors. The source recommendation was adapted by removing the phrase ‘taking into consideration overall disease risk, patient preference and potential adverse effects’. The recommendation was further adapted by adding in the discussions of benefits and risks of endocrine therapy with patients whose cancers contain low levels of ER-positive cells based on the ASCO/CAP guideline update on oestrogen and progesterone receptor testing in breast cancer in 2020, which was based on a systematic review of the evidence to April 2019. The evidence quality was high, and the recommendation was graded ‘strong’ (using ASCO methods). The ASCO/CAP Expert Panel noted that there are limited data on endocrine therapy benefit for cancers with 1% to 10% of cells staining ER positive.