NCCN VERSION 2 2015

NCCN Guidelines Version 2.2015 Invasive Breast Cancer

NCCN Guidelines Index Breast Cancer Table of Contents Discussion

Preoperative Systemic Therapy Guideline LOCAL TREATMENT

ADJUVANT TREATMENT

• 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). • Adjuvant radiation therapy p post-mastectomy is based on prechemotherapy tumor characteristics as per BINV-3 and Endocrine therapy if ER-positive and/or PR-positive x (category 1) • 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. See Adjuvant Endocrine Therapy (BINV-J) • 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). • Adjuvant radiation therapy p post-lumpectomy based on prechemotherapy tumor characteristics as per BINV-2 and Endocrine therapy if ER-positive and/or PR-positive x (category 1) • Complete up to one year of trastuzumab therapy if HER2-positive (category 1). May be administered concurrently with radiation therapy p

Mastectomy and surgical axillary staging j,mm ± reconstruction. If sentinel lymph node biopsy performed prechemotherapy and negative findings, may omit axillary lymph node staging

See Surveillance/

Follow-up (BINV-16)

Lumpectomy with surgical axillary staging. j,mm If sentinel lymph node biopsy performed prechemotherapy and negative findings, may omit axillary lymph node staging See BINV-11

and with endocrine therapy if indicated. See Adjuvant Endocrine Therapy (BINV-J)

j See Surgical Axillary Staging (BINV-D) . p See Principles of Radiation Therapy (BINV-I) . x Chemotherapy and endocrine therapy used as adjuvant therapy should be given sequentially with endocrine therapy following chemotherapy. Available data suggest that sequential or concurrent endocrine therapy with radiation therapy is acceptable. mm Axillary staging following preoperative systemic therapy may include sentinel node biopsy or level I/II dissection. Level I/II dissection should be done for patients who were proven node-positive prior to neoadjuvant therapy (category 2B). Kuehn T, Bauerfeind I, Fehm T, et al. Sentinel-lymph-node biopsy in patients with breast cancer before and after neoadjuvant chemotherapy (SENTINA): a prospective, multicentre cohort study. Lancet Oncol 2013;14(7):609-18. Epub 2013/05/21. Boughey JC, Suman VJ, Mittendorf EA, et al. Sentinel lymph node surgery after neoadjuvant chemotherapy in patients with node-positive breast cancer: the ACOSOG Z1071 (Alliance) clinical trial. JAMA 2013;310(14):1455-61. Epub 2013/10/09.

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-13

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 ® .