Breast cancer: what's new in the NCCN guidelines?

  • Telli ML & al.
  • J Natl Compr Canc Netw
  • 1 May 2019

  • curated by Miriam Davis, PhD
  • Univadis Clinical Summaries
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  • A review article highlights at least 4 major evidence-based updates to the National Comprehensive Cancer Network (NCCN) Guidelines for Breast Cancer (BCa), including foregoing chemotherapy for patients with moderate 21-gene recurrence scores and ovarian suppression for premenopausal patients.

Why this matters

  • New additions specify diagnostic and treatment options.

Key points

  • 21-gene recurrence scores:
    • The 21-gene assay is preferred over other genetic assays because it predicts who benefits from chemotherapy.
    • The TAILORx trial showed that patients with hormone receptor (HR)-positive/node-negative disease and intermediate 21-gene scores (11-25) can forego chemotherapy, relying on endocrine therapy alone.
  • Premenopausal BCa:
    • 8-year updates to the SOFT and TEXT trials indicate that ovarian suppression (using triptorelin, oophorectomy, or ovarian irradiation) should be added to tamoxifen or exemestane for HR+/human epidermal growth factor receptor 2 (HER2)-negative early BCa (eBCa).
  • Managing the axilla in eBCa:
    • Patients with no palpable nodes, 1 or 2 positive sentinel nodes who are getting breast conservation surgery with whole-breast irradiation can avoid full axillary lymph node dissection, according to the ACOSOG Z0011 clinical trial.
  • Metastatic or advanced BCa:
    • Add CDK4/6 inhibitors to aromatase inhibitors in HR+/HER2− patients.
    • Consider new drugs like talazoparib for patients with BRCA1/2 mutations and the new immunotherapy agent atezolizumab for triple-negative breast cancer expressing PD-L1.

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