NCCN Guidelines for Patients® Version Updates: Breast Cancer Stages I & II

Following are the major updates that were included in the NCCN Guidelines for Patients®: Breast Cancer Stages I & II, Version 1.2014

  • Part 3 – Surgery/Reconstruction
    • Page 24
      • This page lists the factors used to decide which breast surgery is possible. In the 2011 version, breast conserving therapy wasn't listed as an option for women who had prior radiation therapy near the breast cancer. Now, the guidelines state breast-conserving therapy may or may not be an option for these women.
    • Page 25
      • This page addresses neoadjuvant therapy for large stage II tumors. Which procedures you should have before neoadjuvant treatment have been clarified. They include:
        • Small metal clips should be placed in your breast to mark the cancer site.
        • An ultrasound of your axillary lymph nodes should be done if the physical exam was normal.
        • If the physical exam or ultrasound suggests cancer is present, a biopsy of your axillary lymph nodes is needed.
        • Axillary lymph nodes that may have cancer should be marked.
  • Part 4 – Chemotherapy/HER2 Inhibitors
    • Page 38
      • This page discusses adjuvant chemotherapy for higher-risk breast cancers that are hormone receptor-positive, HER2 negative. For breast tumors 0.5 cm or smaller with tiny lymph node tumors, the recommendation was changed to "Consider chemotherapy."
    • Page 40
      • This page discusses adjuvant chemotherapy for higher-risk breast cancers that are hormone receptor-positive, HER2-positive. For breast tumors 0.5 cm or smaller with tiny lymph node tumors, the recommendation was changed to "Chemotherapy with trastuzumab is an option." Because the cancer is hormone receptor-positive, hormone therapy would be given after chemotherapy. The other option is to have hormone therapy alone.
    • Page 41
      • This page starts to discuss which chemotherapy regimens are used for stages I and II breast cancer. If the breast cancer is HER2-positive, an HER2 inhibitor is given with chemotherapy. Pertuzumab (Perjeta®) was recently added to the list of possible HER2 inhibitors used for early-stage breast cancer.
    • Pages 42-43
      • These pages list the "preferred" and "other" chemotherapy regimens for HER2-negative tumors. Based on side effects and other experience of the panelists, changes made to the regimens include:
        • Dose-dense AC was moved to "other" regimens.
        • TAC was moved to "other" regimens.
        • A following T followed by C was removed.
    • Page 44-45
      • These pages list the "preferred" and "other" chemotherapy regimens for HER2-positive tumors. Based on new research, changes made to the regimens include:
        • "AC then paclitaxel with pertuzumab and trastuzumab" was added to the "preferred" list as a potential regimen.
        • The following were added to the "other" list as potential regimens:
          • "TCH + pertuzumab"
          • "AC then docetaxel with pertuzumab and trastuzumab"
          • "FEC then docetaxel with pertuzumab and trastuzumab"
          • "Neoadjuvant docetaxel with trastuzumab and pertuzumab" followed by "adjuvant FEC then trastuzumab"
          • "Neoadjuvant paclitaxel with trastuzumab and pertuzumab" followed by "adjuvant FEC then trastuzumab"
        • The following were removed:
          • "Adjuvant docetaxel + trastuzumab followed by FEC"
          • "Neoadjuvant T followed by FEC chemotherapy with trastuzumab"
    • Page 62
      • This page lists which hormone therapy premenopausal women should take. In the chart, initial treatment with tamoxifen is recommended for "5 years." If tamoxifen is continued for extended treatment, it should be taken for another 5 years. Thus tamoxifen may be taken for up to 10 years.
    • Page 63
      • This page lists which hormone therapy postmenopausal women should take. New hormone therapy regimens added to the list include:
        • Aromatase inhibitor for 2 – 3 years followed by tamoxifen to complete 5 years of hormone therapy
        • Consider tamoxifen for 9.5 – 11 years
        • Consider tamoxifen for 10 years if aromatase inhibitors aren't an option