- 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.
- 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.