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NCCN Guidelines Index
Breast Cancer Table of Contents
Discussion
Version2.2015, 03/11/2015© National Comprehensive Cancer Network, Inc. 2015,All rights reserved.The NCCN Guidelines
®
and this illustration may not be reproduced in any form without the express written permission of NCCN
®
.
Note: All recommendations are category 2A unless otherwise indicated.
Clinical Trials: NCCN believes that the best management of any cancer patient is in a clinical trial. Participation in clinical trials is especially encouraged.
BINV-6
NCCN Guidelines Version 2.2015
Invasive Breast Cancer
SYSTEMIC ADJUVANT TREATMENT - HORMONE RECEPTOR-POSITIVE - HER2-NEGATIVE DISEASE
b
b
See Principles of HER2 Testing (BINV-A)
.
v
Mixed lobular and ductal carcinoma as well as metaplastic carcinoma should be graded based on the ductal component and treated based on this grading. The
metaplastic or mixed component does not alter prognosis.
w
Evidence supports that the magnitude of benefit from surgical or radiation ovarian ablation in premenopausal women with hormone receptor-positive breast cancer
is similar to that achieved with CMF alone. Early evidence suggests similar benefits from ovarian suppression (ie, LHRH agonist) as from ovarian ablation.
The combination of ovarian ablation/suppression plus endocrine therapy may be superior to suppression alone. The benefit of ovarian ablation/suppression in
premenopausal women who have received adjuvant chemotherapy is uncertain.
x
Chemotherapy and endocrine therapy used as adjuvant therapy should be given sequentially with endocrine therapy following chemotherapy. Available data suggest
that sequential or concurrent endocrine therapy with radiation therapy is acceptable.
y
There are limited data to make chemotherapy recommendations for those >70 y old. Treatment should be individualized with consideration of comorbid conditions.
bb
The 21-gene RT-PCR assay recurrence score can be considered in select patients with 1–3 involved ipsilateral axillary lymph nodes to guide the addition of
combination chemotherapy to standard hormone therapy. A retrospective analysis of a prospective randomized trial suggests that the test is predictive in this group
similar to its performance in node-negative disease.
See Adjuvant Endocrine Therapy (BINV-J)
and
Neoadjuvant/Adjuvant Chemotherapy (BINV-K)
Histology:
v
• Ductal
• Lobular
• Mixed
• Metaplastic
pT1, pT2, or pT3;
and pN0 or pN1mi
(≤2 mm axillary
node metastasis)
Node positive (one or more
metastases >2 mm to one or more
ipsilateral axillary lymph nodes)
bb
• Tumor ≤0.5 cm or
• Microinvasive
• Tumor >0.5 cm
pN0
pN1mi
Consider adjuvant endocrine therapy (category 2B)
Adjuvant endocrine therapy
w
(category 2B)
± adjuvant chemotherapy
x,y
(category 2B)
Consider
21-gene
RT-PCR
assay
Not done
Low
recurrence
score (<18)
Intermediate
recurrence
score (18-30)
High
recurrence
score (≥31)
Adjuvant endocrine therapy
w
+ adjuvant chemotherapy
x,y
(category 1)
See
Follow-Up
(BINV-16)
Adjuvant endocrine therapy
w
± adjuvant chemotherapy
x,y
(category 1)
Adjuvant endocrine therapy
w
Adjuvant endocrine therapy ±
adjuvant chemotherapy
w,x,y
Adjuvant endocrine therapy +
adjuvant chemotherapy
w,x,y