# ESMO Clinical Practice Guideline for the diagnosis, staging and treatment of patients with metastatic breast cancer

Source: https://onco.cc/key-papers/paper-esmo-metastatic-breast-cancer-guideline-ann-oncol-2021/  
OnCo record `paper-esmo-metastatic-breast-cancer-guideline-ann-oncol-2021` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

The European oncology society's 2021 guideline for breast cancer that has spread, the parent document of the living guideline that is now updated as trials read out.

## Summary

ESMO Clinical Practice Guideline for metastatic breast cancer, published in Annals of Oncology in 2021 by Gennari, André, Barrios, Cortés and colleagues. Europe PMC indexes no abstract for this article, so OnCo carries no figures from it. For triple-negative disease it set pembrolizumab with chemotherapy for PD-L1 combined positive score of 10 or more (KEYNOTE-355), PARP inhibitors for germline BRCA carriers (OlympiAD, EMBRACA) and sacituzumab govitecan after two lines (ASCENT). The guideline has since been maintained as the ESMO Metastatic Breast Cancer Living Guideline, whose 2025 update is recorded separately.

## Fields

- Kind: Key paper
- Last checked: 2026-09-24
- Tags: tnbc-evidence
- Journal: Annals of Oncology
- Year: 2021
- DOI: 10.1016/j.annonc.2021.09.019
- Authors: Gennari A, André F, Barrios CH, et al.
- Findings: No abstract is indexed on Europe PMC; recommendations are read from the guideline itself.
- What it means: The document that made immunotherapy, PARP inhibition and the first antibody-drug conjugate the European standard for metastatic triple-negative disease; every later first-line change is an amendment to it.
- Caveats: Predates the first-line antibody-drug conjugate trials (ASCENT-03, ASCENT-04, TROPION-Breast02).; No abstract indexed; figures are not quoted.

## Sources

- Ann Oncol 2021: https://doi.org/10.1016/j.annonc.2021.09.019
- PubMed: https://pubmed.ncbi.nlm.nih.gov/34678411/
- ESMO Metastatic Breast Cancer Living Guideline: https://www.esmo.org/living-guidelines

## Connected records

- collections: [ESMO Clinical Practice Guidelines & MCBS](https://onco.cc/collections/esmo-guidelines/)
- key papers: [Updated treatment recommendations for systemic treatment: from the ESMO Metastatic Breast Cancer Living Guideline](https://onco.cc/key-papers/paper-esmo-mbc-living-guideline-update-ann-oncol-2025/)
- cancers: [HER2-positive breast cancer](https://onco.cc/cancers/breast-her2-positive/), [HR-positive / HER2-negative breast cancer](https://onco.cc/cancers/breast-hr-positive/), [Triple-negative breast cancer (TNBC)](https://onco.cc/cancers/tnbc/)
- institutions: [European Society for Medical Oncology (ESMO)](https://onco.cc/institutions/esmo/)
- trials: [ASCENT](https://onco.cc/trials/ascent/), [EMBRACA](https://onco.cc/trials/embraca/), [KEYNOTE-355](https://onco.cc/trials/keynote-355/), [OlympiAD](https://onco.cc/trials/olympiad/)
- people: [Javier Cortés](https://onco.cc/people/javier-cortes/)
- journals: [Annals of Oncology](https://onco.cc/journals/annals-of-oncology/)

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