NCCN VERSION 2 2015

NCCN Guidelines Version 2.2015

NCCN Guidelines Index Breast Cancer Table of Contents Discussion

Breast Cancer Updates Updates in Version 1.2015 of the NCCN Guidelines for Breast Cancer from Version 3.2014 include:

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."

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.”

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.

UPDATES-4

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 ® .