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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-15
NCCN Guidelines Version 2.2015
Invasive Breast Cancer
PREOPERATIVE SYSTEMIC THERAPY FOR LOCALLY ADVANCED INVASIVE BREAST CANCER (NON-INFLAMMATORY)
n
See Principles of Breast Reconstruction Following Surgery (BINV-H)
.
p
See Principles of Radiation Therapy (BINV-I)
.
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 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
Admistration of all chemotherapy prior to surgery is preferred.
kk
See Definition of Menopause (BINV-L)
.
nn
For patients with skin and/or chest wall involvement (T4 non-inflammatory) prior to neoadjuvant therapy, breast conservation may be performed in carefully selected
patients based on a multidisciplinary assessment of local recurrence risk. In addition to standard contraindications to breast conservation (
see BINV-G
), exclusion criteria
for breast conservation include: inflammatory (T4d) disease before neoadjuvant therapy and incomplete resolution of skin involvement after neoadjuvant therapy.
Preoperative
systemic
therapy
gg,hh,ii,jj
(endocrine therapy
alone may be
considered for
receptor-positive
disease in
postmenopausal
patients)
kk
LOCOREGIONAL TREATMENT
ADJUVANT TREATMENT
Total mastectomy + level l/ll axillary
dissection + radiation therapy to chest
wall and infraclavicular and
supraclavicular nodes (plus internal
mammary nodes if involved, strongly
consider internal mammary nodes if not
clinically involved [category 2B]) ±
delayed breast reconstruction
n
or
Consider lumpectomy
nn
+ level l/ll
axillary dissection + radiation therapy to
breast and infraclavicular and
supraclavicular nodes (plus internal
mammary nodes if involved)
Response
No response
Consider additional systemic
chemotherapy and/or preoperative
radiation
• Complete planned chemotherapy
regimen course if not completed
preoperatively plus endocrine
treatment if ER-positive and/or PR-
positive (sequential chemotherapy
followed by endocrine therapy).
• Complete up to one year of
trastuzumab therapy if HER2-
positive (category 1). May be
administered concurrently with
radiation therapy
p
and with
endocrine therapy if indicated.
Response - See above pathway
No response
Individualized
treatment
See
Surveillance/
Follow-up
(BINV-16)