NCCN VERSION 2 2015

NCCN Guidelines Version 2.2015 Invasive Breast Cancer Preoperative Systemic Therapy Guideline (Stage IIA-IIIA) PRIMARY TREATMENT RESPONSE ll

NCCN Guidelines Index Breast Cancer Table of Contents Discussion

Confirmed progressive disease at any time

See Mastectomy (BINV-13)

Preoperative systemic therapy gg,hh,ii,jj (endocrine therapy alone may be considered for receptor-positive disease in postmenopausal patients) kk

Partial response, lumpectomy not possible

Partial response, lumpectomy possible or Complete response

See Lumpectomy (BINV-13)

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.

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

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 ® .