NCCN Guidelines Version 2.2015
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.
PAGET-2
• Added the following treatment options:
Central lumpectomy including NAC with whole breast radiation therapy
or
Total mastectomy c ± sentinel node biopsy with or without breast
reconstruction
or
Central lumpectomy including NAC ± sentinel node biopsy without
radiation therapy (category 2B)
• Removed the following footnotes:
"With Paget’s disease and no associated peripheral cancer, or with
associated ER-positive DCIS, consider tamoxifen 20 mg per day for 5
years."
"With associated invasive breast cancer, treat with appropriate systemic
adjuvant therapy."
PREG-1
• Modified footnote "c": replaced "trastuzumab" with "anti-HER2 therapy."
IBC-1
• Footnote "a": removed the following statement "...and with a palpable
border to erythema."
• Footnote "j" is new to the page “A pertuzumab-containing regimen may be
administered preoperatively to patients with HER2-positive IBC.”
Breast Cancer Updates
Updates in Version 1.2015 of the NCCN Guidelines for Breast Cancer from Version 3.2014 include:
UPDATES-4
BINV-N (1 of 7)
• Added the following to footnote"4": "Patients previously treated with
chemotherapy plus trastuzumab in the absence of pertuzumab in the
metastatic setting, may be considered for one line of therapy including both
trastuzumab plus pertuzumab in combination with or without cytotoxic
therapy (such as vinorelbine or taxane). Further research is needed to
determine the ideal sequencing strategy for anti-HER2 therapy."
BINV-N (2 of 7)
• Modified dose schedule for docetaxel; "35 mg/m
2
IV weekly for 6 wks
followed by a 2-week rest, then repeat."
BINV-N (3 of 7)
• Modified dose schedule for FAC chemotherapy; for "cycled every 21 days"
removed "for 6 cycles."
BINV-N (6 of 7)
• Added reference "Rivera E, Mejia JA, Arun BJ, et al. Phase 3 study
comparing the use of docetaxel on an every-3-week versus weekly schedule
in the treatment of metastatic breast cancer. Cancer 2008 Apr 1;112(7):1455-
61."
BINV-N (7 of 7)
• Added reference to support docetaxel/capecitabine chemotherapy
combination; Mavroudis D, Papakotoulas P, Ardavanis A, et al. Randomized
phase III trial comparing docetaxel plus epirubicin versus docetaxel plus
capecitabine as first-line treatment in women with advanced breast cancer.
Ann Oncol 21:48(2010).
PHYLL-1
• Added footnote "d" to wide excision without axillary staging: "There are
no prospective randomized data supporting the use of radiation treatment
with phyllodes tumors. However, in the setting where additional recurrence
would create significant morbidity (eg, chest wall recurrence following
mastectomy), radiation therapy may be considered following the same
principles that are applied to the treatment of soft tissue sarcoma."