The Japanese Breast Cancer Society Clinical Practice Guidelines for systemic treatment of breast cancer, 2022 edition
Japanese Breast Cancer Society · 2023 · Japan
Source and licence
- Authors
- Mitsuo Terada, Aki Ito, Yuichiro Kikawa et al.
- Title
- The Japanese Breast Cancer Society Clinical Practice Guidelines for systemic treatment of breast cancer, 2022 edition
- Journal
- Breast Cancer (Tokyo, Japan), 2023
- Licence
- CC BY 4.0
- Changes
- Verbatim excerpts; formatting adapted
Full text retrieved 2026-10-27 from Europe PMC · PMC10587293
Licence statement of the original publication
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This page reproduces excerpts of the original publication; the original is authoritative. It has not been reviewed by a physician, does not state a recommendation of Medelix and does not replace medical advice. The guideline may have been updated since.
Open the original publication →Full text on Europe PMC
Recommendations
Verbatim, with grade of recommendation or strength of consensus where given.
CQ.5 Is concurrent use of S-1 with ET recommended as adjuvant therapy for patients with HR-positive, HER2-negative EBC?
- RecommendationConcurrent use of S-1 with ET for 1 year is strongly recommended for patients with a high risk of recurrence [SoR: 1; SoE: Moderate; consensus rate: 72% (31/43)].
CQ.6 Is abemaciclib combined with ET recommended as adjuvant therapy for patients with HR-positive, HER2-negative EBC?
- RecommendationConcurrent use of abemaciclib with ET for 2 years is strongly recommended for patients with a high risk of recurrence [SoR: 1; SoE: Moderate; consensus rate: 75% (27/36)].
CQ.15 Is trastuzumab monotherapy recommended as adjuvant therapy for elderly patients with HER2-positive EBC?
- RecommendationTrastuzumab monotherapy is weakly recommended for elderly patients who have difficulty receiving chemotherapy [SoR: 2; SoE: Weak; consensus rate: 98% (46/47)].
CQ.16 Is an immune checkpoint inhibitor recommended as neoadjuvant/adjuvant therapy for patients with triple-negative EBC?
- RecommendationPembrolizumab (anti-PD-1 antibody) is weakly recommended [SoR: 2; SoE: Moderate; consensus rate: 80% (32/40)].
CQ.18 What is recommended as first-line ET for premenopausal patients with HR-positive, HER2-negative MBC?
- RecommendationOFS in combination with a CDK4/6 inhibitor and a nonsteroidal aromatase inhibitor (NSAI) is recommended [SoR: 1–2 (no agreement reached*); SoE: Weak; consensus rate: strong recommendation: 53% (18/34), moderate recommendation: 47% (16/34)]. The SoR was rated 1–2 since a consensus of > 70% was not reached even after three rounds of voting. The combination of OFS and ET alone is weakly recommended. The combination of OFS and tamoxifen is weakly recommended [SoR: 2; SoE: Moderate; consensus rate: 95% (39/41)]. The combination of OFS and a NSAI is weakly recommended [SoR: 2; SoE: Weak; consensus rate: 100% (41/41)].
CQ.24 Are oral fluoropyrimidines recommended as first- or second-line chemotherapy for patients with HER2-negative MBC?
- For first-line therapy, S-1 is weakly recommended [SoR: 2; SoE: Moderate; consensus rate: 86% (38/44)] and capecitabine is weakly recommended [SoR: 2; SoE: weak; consensus rate: 86% (38/44)]. Oral fluoropyrimidines have an advantage of causing no hair loss. Recommendation of these drugs as first-line chemotherapy was examined through comparison with other drugs.
CQ.28 Is T-DXd recommended as second-line therapy for patients with HER2-positive MBC?
- RecommendationT-DXd is strongly recommended as second-line therapy for patients with HER2-positive MBC that has progressed during or after the combination of trastuzumab, pertuzumab and chemotherapy [SoR: 1; SoE: Moderate; consensus rate: 90% (36/40)].
CQ.33 (former FRQ5) Are PARP inhibitors recommended as adjuvant therapy for patients with germline BRCA1/2 pathogenic variant-positive EBC?
- RecommendationOlaparib for 1 year after perioperative chemotherapy is strongly recommended for patients with HER2-negative disease and a high risk of recurrence [SoR: 1; SoE: Moderate; consensus rate: 90% (66/73)]. We note that CQ.33 was elevated from a FRQ after publication of the 2022 edition of the guidelines. Therefore, the recommendation decision meeting was conducted on a different day to that for the other CQs, and a vote was held in April 2023.
Abstract
The Japanese Breast Cancer Society (JBCS) Clinical Practice Guidelines for systemic treatment of breast cancer were updated to the 2022 edition through a process started in 2018. The updated guidelines consist of 12 background questions (BQs), 33 clinical questions (CQs), and 20 future research questions (FRQs). Multiple outcomes including efficacy and safety were selected in each CQ, and then quantitative and qualitative systematic reviews were conducted to determine the strength of evidence and strength of recommendation, which was finally determined through a voting process among designated committee members. Here, we describe eight selected CQs as important updates from the previous guidelines, including novel practice-changing updates, and recommendations based on evidence that has emerged specifically from Japanese clinical trials.
Supplementary Information: The online version contains supplementary material available at 10.1007/s12282-023-01505-x.
Contents of the original publication
The section headings of the original.
- Introduction
- Background questions (BQs) and clinical questions (CQs)
- Important updates on recommendations
- CQ.5 Is concurrent use of S-1 with ET recommended as adjuvant therapy for patients with HR-positive, HER2-negative EBC?
- CQ.6 Is abemaciclib combined with ET recommended as adjuvant therapy for patients with HR-positive, HER2-negative EBC?
- CQ.15 Is trastuzumab monotherapy recommended as adjuvant therapy for elderly patients with HER2-positive EBC?
- CQ.16 Is an immune checkpoint inhibitor recommended as neoadjuvant/adjuvant therapy for patients with triple-negative EBC?
- CQ.18 What is recommended as first-line ET for premenopausal patients with HR-positive, HER2-negative MBC?
- CQ.24 Are oral fluoropyrimidines recommended as first- or second-line chemotherapy for patients with HER2-negative MBC?
- CQ.28 Is T-DXd recommended as second-line therapy for patients with HER2-positive MBC?
- CQ.33 (former FRQ5) Are PARP inhibitors recommended as adjuvant therapy for patients with germline BRCA1/2 pathogenic variant-positive EBC?
- Future research questions (FRQs)
- Conclusion
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