Professor Shaohua Zhang: "CSCO BC Guidelines" Updated, Evidence-Based, Leading Chinese Clinical Practice

Editor’s Note: The “Chinese Society of Clinical Oncology (CSCO) Breast Cancer Diagnosis and Treatment Guidelines (2024 Edition)” (“CSCO BC Guidelines”) have been updated again, incorporating richer evidence-based medicine from early to late stages, introducing more new treatment strategies and options. It has influenced the field of breast cancer treatment in China significantly. “Oncology Frontier” interviewed Professor Shaohua Zhang from The Fifth Medical Center of the People’s Liberation Army General Hospital to discuss the highlights and clinical significance of the updated “CSCO BC Guidelines”.

“Oncology Frontier”: Once the “CSCO BC Guidelines” were released, they were warmly received and highly praised by clinical doctors. What aspects of the CSCO BC Guidelines do you think have enabled them to quickly integrate into clinical practice in China?

Professor Shaohua Zhang: Since its first release in 2017, the “CSCO BC Guidelines” have been updated to the eighth edition. We continuously uphold the principle of “learning, absorbing, innovating, and improving” of the Chinese Society of Clinical Oncology Breast Cancer Expert Committee (CSCO BC), learning from and absorbing the advantages of guidelines at home and abroad. Based on evidence-based medicine and considering accessibility, we innovate and improve to develop breast cancer diagnosis and treatment guidelines that best suit the national conditions of China. During the annual guideline lectures, we strive to cover provincial, municipal, and county-level hospitals, and collect and organize feedback. With each update, we listen to voices from doctors at different levels. The unchanged principle of the “CSCO BC Guidelines” is to continue implementing the principles of classification and stratified treatment. The change lies in evidence-based medicine, aiming to achieve more precise and optimized guidance. We look forward to more Chinese elements, such as products and voices, continuously joining the guidelines.

“Oncology Frontier”: After incorporating new evidence-based medicine, what are the significant updates in surgical treatment and early systemic treatment in the new edition of the CSCO BC Guidelines?

Professor Shaohua Zhang: Unlike the multiple versions released annually by the “National Comprehensive Cancer Network Breast Cancer Clinical Practice Guidelines” (“NCCN Breast Cancer Guidelines”), the “CSCO BC Guidelines” are updated once a year. We usually hold an annual review and guideline update discussion meeting in early January, reviewing new evidence-based medicine from the previous year and considering factors such as product approval and medical insurance access. In the 2024 edition of the “CSCO BC Guidelines,” adjustments have been made in the treatment of early breast cancer based on recent clinical research findings. For example, the addition of pertuzumab or trastuzumab combined subcutaneous formulations and consideration of using ribociclib for eligible patients based on the latest NATALEE clinical trial results.

“Oncology Frontier”: Late-stage treatment is an area where many new drugs are emerging. What are the highlights of the new edition of the CSCO BC Guidelines in the field of late-stage treatment?

Professor Shaohua Zhang: Based on the principles of classified treatment, in the field of HER2-positive breast cancer, according to the PHILA study published online in November 2023 in the “British Medical Journal” (BMJ), the evidence level of the combination of pertuzumab and trastuzumab-sensitive populations may be raised. For patients who fail pertuzumab treatment, the National Medical Products Administration of China approved the indication of DS-8201 (trastuzumab deruxtecan) in February last year, so the recommendation level of DS-8201 will also be further increased. In the triple-negative breast cancer (TNBC) field, based on the TORCHLIGHT study published online in January 2024 in “Nature Medicine,” the recommendation of chemotherapy combined with immunotherapy has been added. Specifically, for patients who meet the clinical research conditions, the treatment regimen of albumin-bound paclitaxel combined with PD-1 monoclonal antibody can be considered. At the same time, the “CSCO BC Guidelines” have clarified that in clinical practice, immunotherapy can be used for patients with a CPS score >1. More importantly, we have changed the pathological classification of HER2 from the traditional “binary” to “ternary,” and added a special section on salvage treatment for HER2 low-expression advanced breast cancer.

“Oncology Frontier”: With the development and changes in treatment models, how do you think the form and carrier of CSCO guidelines are changing?

Professor Shaohua Zhang: Medicine is an imperfect science, and there are still many unknown areas. For example, we cannot accurately predict the treatment efficacy and survival period of patients because the current objective response rate and median survival period are data for the overall population, which is difficult to be accurate to individuals. However, overall, medicine is constantly advancing, and our guidelines are also continuously updated. From full-text versions to simplified versions (pocket books), from text versions to artificial intelligence versions, each year takes a small step, and every ten years takes a big step. Looking back over the past eight years, there have been significant changes in the guidelines, especially in the artificial intelligence version. In addition to providing specific treatment plans and strategies like intelligent map navigation, it can also provide evidence-based medicine behind it and even support in drug economics, such as medical insurance costs. The patient education version is dedicated to asking and solving problems from the perspective of patients, providing convenience for patients, which is also an important part of doctor-patient communication in the comprehensive management model of breast cancer.