NICE has issued updated guidance on the management of early and locally advanced breast cancer. It recommends that postmenopausal women with oestrogen receptor (ER)-positive invasive breast cancer who have been taking tamoxifen for two to five years and who are at medium or high risk of disease recurrence, should be offered extended (>5 yrs) therapy with an aromatase inhibitor.
NICE recommends tamoxifen as initial adjuvant endocrine therapy for men and premenopausal women with ER‑positive invasive breast cancer. Aromatase inhibitors are recommended as initial adjuvant endocrine therapy for postmenopausal women with ER‑positive invasive breast cancer who are at medium or high risk of disease recurrence. Tamoxifen is recommended for women with low risk of recurrence, or where aromatase inhibitors are not tolerated or contraindicated.
Ovarian function suppression should be considered in addition to endocrine therapy for premenopausal women with ER‑positive invasive breast cancer.
Chemotherapy of choice should contain both a taxane and an anthracycline.
Patients with T1c and above HER2‑positive invasive breast cancer should be offered adjuvant trastuzumab, given at three‑week intervals for one year in combination with surgery, chemotherapy and radiotherapy as appropriate, NICE recommends.
Adjuvant trastuzumab can be considered for patients with T1a/T1b HER2‑positive invasive breast cancer, taking into account comorbidities, prognostic features, and possible chemotherapy toxicity.
During trastuzumab treatment, cardiac function should be assessed every three months. If left ventricular ejection fraction (LVEF) drops by 10% or more from baseline and to below 50%, suspend trastuzumab and restart only after reassessing cardiac function and discussing the possible benefits and risks. Cardiac function assessments should be repeated every 6 months for the following 24 months after the discontinuation of trastuzumab.
The full guidelines are available here.