2024 CSCO Breast Cancer guidelines revolutionize treatment approaches in China

Breast cancer remains a major global health challenge, with treatment strategies varying widely across regions. The continuous development of new therapies, combined with the pressing need to personalize treatments for diverse patient populations, underscores the importance of evidence-based guidelines that blend global innovations with local healthcare needs. This challenge calls for guidelines that not only reflect international advancements but also take into account the clinical realities and accessibility within specific regions, particularly in China.

The 2024 Chinese Society of Clinical Oncology Breast Cancer (CSCO BC) guidelines, released (DOI: 10.20892/j.issn.2095-3941.2024.0374) in Cancer Biology & Medicine, represent a pioneering effort by a team from Fifth Medical Center of PLA General Hospital and the Beijing Institute of Biotechnology, Academy of Military Medical Sciences, to provide updated, region-specific treatment recommendations. These guidelines offer a comprehensive approach to managing breast cancer, informed by both high-quality clinical studies and real-world data from China, ensuring that the treatment strategies are both globally relevant and locally applicable.

The updated guidelines place a strong emphasis on precision medicine, offering tailored treatment approaches for various subtypes of breast cancer. For HER2-positive cancers, the guidelines advocate for dual-target therapies such as trastuzumab and pertuzumab, along with the introduction of pyrotinib in combination with trastuzumab as a novel regimen. This new combination is supported by data from the PHEDRA study, which showed significant improvements in pathologic complete response rates.

In triple-negative breast cancer (TNBC), the guidelines highlight the importance of immunotherapy, referencing the TORCHLIGHT study which demonstrated enhanced progression-free and overall survival with the addition of toripalimab to nab-paclitaxel. Notably, the guidelines also address HER2 low-expression breast cancer, recommending a personalized treatment approach based on hormone receptor status and previous treatments, including the use of antibody-drug conjugates (ADCs), or targeted therapies after ADC failure. These advancements reflect a broader global trend towards precision oncology, aiming to optimize treatment effectiveness based on individual tumor characteristics.

Dr. Zefei Jiang, principal author of the 2024 CSCO BC guidelines, emphasizes the transformative potential of these updates: "The 2024 guidelines are a reflection of the powerful synergy between global research advancements and clinical insights from China. By integrating these perspectives, we ensure that our recommendations are not only at the cutting edge of scientific innovation but are also grounded in the practical realities of our healthcare system. Our goal is to create a balanced framework that aligns international standards with the unique needs of Chinese patients, ultimately enhancing care and improving outcomes."

The 2024 CSCO BC guidelines are poised to revolutionize breast cancer care in China, with the potential to significantly improve patient outcomes and reduce treatment disparities. By prioritizing the generation of local evidence, these guidelines pave the way for more personalized treatment protocols tailored to the specific genetic and clinical profiles of Chinese patients. This approach promises not only to benefit China's domestic patient population but also to contribute valuable data to the global oncology community, enriching international discussions on breast cancer management. The broader implications of these guidelines are profound, as they aim to narrow gaps in treatment efficacy and create a more equitable landscape in the global fight against breast cancer.