Diagnosis
Extended Endocrine Therapy
Î If a patient has ER/PgR-positive, HER2-negative (node-negative) breast
cancer and has had 5 years of endocrine therapy without evidence of
recurrence, the clinician should NOT use multiparameter gene expression
or protein assays (Oncotype DX, EndoPredict, PAM50, Breast Cancer
Index, or IHC4) to guide decisions on extended endocrine therapy.
(Moderate Recommendation; EB-I)
Additional Biomarkers to Guide Specific Drug/Regimen Choice
Tamoxifen
Î The clinician should NOT use CYP2D6 polymorphisms to guide adjuvant
endocrine therapy selection. (Moderate Recommendation; EB-I)
Î The clinician should NOT use p27 expression by IHC to guide adjuvant
endocrine therapy selection. (Strong Recommendation; IC-L)
Aromatase Inhibitors
Î The clinician should NOT use protein encoded by the MKI67 gene labeling
index by IHC to guide adjuvant endocrine therapy selection. (Moderate
Recommendation; EB-I)
Taxanes
Î The clinician should NOT use microtubule-associated protein Tau mRNA
expression or mRNA expression by IHC to guide adjuvant chemotherapy
selection. (Moderate Recommendation; EB-I)
Î The clinician should NOT use HER1/epidermal growth factor receptor
expression by IHC to guide adjuvant chemotherapy selection. (Moderate
Recommendation; EB-L)
Anthracyclines
Î The clinician should NOT use TOP2A gene amplification or TOP2A protein
expression by IHC to guide adjuvant chemotherapy selection. (Moderate
Recommendation; EB-H)
Î The clinician should NOT use HER2 and TOP2A gene coamplification;
CEP17 duplication; or TIMP-1, FOXP3, or p53 to guide adjuvant
chemotherapy selection. (Moderate Recommendation; EB-I)
Trastuzumab
Î If a patient has HER2-positive breast cancer, the clinician should NOT
use phosphatase and tensin homolog (PTEN) to guide adjuvant therapy
selection. (Moderate Recommendation; EB-I)
Î If a patient has HER2-positive breast cancer, the clinician should NOT
use soluble HER2 levels to guide selection of type of adjuvant therapy.
(Moderate Recommendation; EB-L)
