NCCN Guidelines for Patients® Version Updates: Breast Cancer Stage IV

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

  • Part 2 – Treatment planning
    • Page 13
      • This page describes some of the imaging tests recommended for metastatic breast cancer. FDG PET/CT was added as an optional test. This test is most helpful when other imaging tests are unclear. It may help to find metastases to lymph nodes, bones, and other distant sites.
  • Part 3 – Treatment overview
    • Pages 19 and 23
      • These pages describe some of the hormone and targeted therapy drugs used for metastatic cancer. Exemestane with everolimus is a new drug regimen. However, it is recommended only for very specific circumstances. Ask your doctor for more information.
  • Part 4 – Treatment guide
    • Page 28
      • This page lists the treatment recommended for breast cancer that is hormone receptor-positive. The following changes were made:
        • "Antiestrogens alone" was removed as an option for women who are premenopausal and who didn't take any hormone therapy in the past year.
        • "SERMs alone" was added as an option.
        • "Antiestrogen" is still listed as an option for women who are postmenopausal and who didn't take any hormone therapy in the past year. However, antiestrogens now include both SERMs and SERD. Read page 18 for more information.
    • Page 30
      • This page lists the treatment options for breast cancer that is hormone therapy-refractory. The following changes were made:
        • For HER2-positive tumors, "trastuzumab and pertuzumab with paclitaxel or docetaxel" was added as an option.
        • If you are given either regimen listed for HER2-positive tumors and it fails to work, you should continue to take treatment for HER2-positive breast cancer. Ado-trastuzumab emtansine as the preferred treatment option.
        • Ado-trastuzumab emtansine was added as a preferred therapeutic option in the treatment of HER2-positive, metastatic breast cancer.
  • Part 5 – Receiving cancer treatment
    • Page 38
      • This page lists the chemotherapy recommendations for breast cancer that is HER2-negative. The following changes were made:
        • The following were moved from "preferred" to "other" agent:
          • Albumin-bound paclitaxel
          • Docetaxel
          • Epirubicin
        • Mitoxantrone was removed.
        • Gemcitabine/carboplatin was added to the list of combination therapies.
        • The following were removed from the list of combination regimens:
          • AT (doxorubicin/docetaxel or doxorubicin/paclitaxel)
          • "Ixabepilone and capecitabine"
    • Page 39
      • This page lists the chemotherapy recommendations for breast cancer that is HER2-positive. The following changes were made:
        • The following were added to "preferred" first-line treatment:
          • "Pertuzumab + trastuzumab + docetaxel"
          • "Pertuzumab + trastuzumab + paclitaxel"
        • All other trastuzumab combinations are now "Other" first-line treatments.
        • Other first-line agents for HER2-positive disease: Changed "trastuzumab with" to "trastuzumab alone or with."
        • Ado-trastuzumab emtansine was added to the second-line treatments. It is preferred over other regimens.
    • Page 41
      • This page addresses the recommendations for checking treatment results. This page is new to the guidelines.