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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-12
NCCN Guidelines Version 2.2015
Invasive Breast Cancer
Preoperative Systemic Therapy Guideline (Stage IIA-IIIA)
PRIMARY TREATMENT
RESPONSE
ll
Confirmed progressive
disease at any time
Partial response,
lumpectomy not possible
Partial response,
lumpectomy possible
or
Complete response
Preoperative systemic therapy
gg,hh,ii,jj
(endocrine therapy alone may be
considered for receptor-positive
disease in postmenopausal patients)
kk
gg
A number of chemotherapy regimens have activity in the preoperative setting. In general, those chemotherapy regimens recommended in the adjuvant setting may be
considered in the preoperative setting.
See Neoadjuvant/Adjuvant Chemotherapy (BINV-K)
. If treated with endocrine therapy, an aromatase inhibitor is preferred for
postmenopausal women.
hh
Patients with HER2-positive tumors should be treated with preoperative systemic therapy incorporating trastuzumab for at least 9 weeks of preoperative therapy.
See Neoadjuvant/Adjuvant Chemotherapy (BINV-K)
.
ii
A pertuzumab-containing regimen may be administered preoperatively to patients with greater than or equal to T2 or greater than or equal to N1, HER2-positive breast
cancer.
jj
Administration of all chemotherapy prior to surgery is preferred.
See Neoadjuvant/Adjuvant Chemotherapy (BINV-K)
.
kk
See Definition of Menopause (BINV-L).
ll
The accurate assessment of in-breast tumor or regional lymph node response to preoperative chemotherapy is difficult, and should include physical examination and
performance of imaging studies that were abnormal at the time of initial tumor staging. Selection of imaging methods prior to surgery should be determined by the
multidisciplinary team.
See
Mastectomy
(BINV-13)
See
Lumpectomy
(BINV-13)