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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
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and this illustration may not be reproduced in any form without the express written permission of NCCN
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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.
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NCCN Guidelines Version 2.2015
Invasive Breast Cancer
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Rising tumor markers (eg, CEA, CA15-3, CA27.29) are concerning for tumor progression, but may also be seen in the setting of responding disease. An isolated
increase in tumor markers should rarely be used to declare progression of disease. Changes in bone lesions are often difficult to assess on plain or cross-sectional
radiology or on bone scan. For these reasons, patient symptoms and serum tumor markers may be more helpful in patients with bone-dominant metastatic disease.
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PRINCIPLES OF MONITORING METASTATIC DISEASE
Monitoring of patient symptoms and cancer burden during treatment of metastatic breast cancer is important to determine whether the
treatment is providing benefit and that the patient does not have toxicity from an ineffective therapy.
Components of Monitoring:
Monitoring includes periodic assessment of varied combinations of symptoms, physical examination, routine laboratory tests, imaging
studies, and blood biomarkers where appropriate. Results of monitoring are classified as response/continued response to treatment, stable
disease, uncertainty regarding disease status, or progression of disease. The clinician typically must assess and balance multiple different
forms of information to make a determination regarding whether disease is being controlled and the toxicity of treatment is acceptable.
Sometimes, this information may be contradictory.
Definition of Disease Progression:
Unequivocal evidence of progression of disease by one or more of these factors is required to establish progression of disease, either
because of ineffective therapy or acquired resistance of disease to an applied therapy. Progression of disease may be identified through
evidence of growth or worsening of disease at previously known sites of disease and/or of the occurrence of new sites of metastatic disease.
• Findings concerning for progression of disease include:
Worsening symptoms such as pain or dyspnea
Evidence of worsening or new disease on physical examination
Declining performance status
Unexplained weight loss
Increasing alkaline phosphatase, ALT, AST, or bilirubin
Hypercalcemia
New radiographic abnormality or increase in the size of pre-existing radiographic abnormality
New areas of abnormality on functional imaging (eg, bone scan, PET/CT scan)
Increasing tumor markers (eg, CEA, CA15-3, CA27.29)
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