NCCN VERSION 2 2015

NCCN Guidelines Version 2.2015 Breast Cancer Updates

NCCN Guidelines Index Breast Cancer Table of Contents Discussion

Updates in Version 2.2015 of the NCCN Guidelines for Breast Cancer from Version 1.2015 include: BINV-F

BINV-5 • Changed pN0 "Consider adjuvant endocrine therapy" to "Consider adjuvant endocrine therapy ± adjuvant chemotherapy with trastuzumab (category 2B)." • Added footnote "aa" stating "A pertuzumab-containing regimen can be administered to patients with greater than or equal to T2 or greater than or equal to N1, HER2-positive, early-stage breast cancer." (Also applies to BINV-7 ) BINV-6 • Added footnote "bb" stating "The 21-gene RT-PCR assay recurrence score can be considered in select patients with 1–3 involved ipsilateral axillary lymph nodes to guide the additon of combination chemotherapy to standard hormone therapy. A retrospective analysis of a prospective randomized trial suggests that the test is predictive in this group similar to its performance in node-negative disease." • Added the following footnote: "Palbociclib in combination with letrozole may be considered as a treatment option for first-line therapy for postmenopausal patients with ER-positive, HER2-negative metastatic breast cancer." BINV-M • Changed page heading from "Subsequent Endocrine Therapy for Systemic Disease" to "Endocrine Therapy for Recurrent or Stage IV Disease." • Added palbociclib + letrozole as a therapuetic option for postmenopausal patients with ER-positive, HER2-negative metastatic breast cancer.

• The following sentence has been removed from the second paragraph: "This can be achieved with brachytherapy or electron beam or photon fields. " BINV-G • Changed "Focally positive" to "Diffusely positive pathologic margins."

Updates in Version 1.2015 of the NCCN Guidelines for Breast Cancer from Version 3.2014 include: DCIS-1 • Modified footnote "h" stating Complete axillary lymph node

dissection should not be performed in the absence of evidence of invasive cancer or proven axillary metastatic disease in women with apparent pure DCIS. However, a small proportion of patients with apparent pure DCIS will be found to have invasive cancer at the time of their definitive surgical procedure. Therefore, the performance of a sentinel lymph node procedure should be strongly considered if the patient with apparent pure DCIS is to be treated with mastectomy or with excision in an anatomic location compromising the performance of a future sentinel lymph node procedure. BINV-2 • Modified the statement "Radiation therapy should follow chemotherapy when chemotherapy is indicated" to "It is common for radiation therapy to follow chemotherapy when chemotherapy is indicated." BINV-3 • Changed "close margins" to "negative margins but <1 mm." • Negative axillary nodes and tumor ≤5 cm and margins ≥1 mm, "No radiation therapy" added a footnote stating: "Postmastectomy radiation therapy may be considered for patients with multiple high-risk recurrence factors."

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Version 2.2015, 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 ® .

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