Breast Cancer, Version 4.2017, NCCN Clinical Practice Guidelines in Oncology

Gradishar, William J.; Anderson, Benjamin O.; Balassanian, Ronald; Blair, Sarah L.; Burstein, Harold J.; Cyr, Amy; Elias, Anthony; Farrar, William B.; Forero, Andres; Giordano, Sharon H.; Goetz, Matthew P.; Goldstein, Lori J.; Isakoff, Steven J.; Lyons, Janice A.; Marcom, P. Kelly; Mayer, Ingrid A.; McCormick, Beryl; Moran, Meena S.; O’Regan, Ruth; Patel, Sameer A.; Pierce, Lori J.; Reed, Elizabeth; Salerno, Kilian E.; Schwartzberg, Lee S.; Sitapati, Amy M.; Smith, Karen L.; Smith, Mary Lou; Soliman, Hatem; Somlo, George; Telli, Melinda L.; Ward, John H.; Kumar, Rashmi; Shead, Dorothy A.

doi:10.6004/jnccn.2018.0012

Cited by 489 publications

(250 citation statements)

References 4,936 publications

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“…With the improvement of the efficacy of NAC and targeted therapy guided by the molecular subtypes, pathological complete response (pCR) rate is increasing, especially in HER2+ (with targeted therapy) and TN breast cancer patients, whose pCR rates can reach 60% or higher . pCR after NAC can not only be used as a surrogate marker for long‐term survival of breast cancer patients, but also affect the local regional de‐escalation management for breast cancer …”

Section: Discussionmentioning

confidence: 99%

“…With the development of SLNB, it has become the standard staging technology for initial cN0 patients, but there is currently no consensus on the optimal time of SLNB for cN0 patients receiving NAC. NCCN Breast Cancer Clinical Practice Guide V1 and V2 (2017) recommended that SLNB could be performed before and after NAC for cN0 patients receiving NAC, but the guides after V3 recommended that SLNB should be performed after NAC . In the St. Gallen Expert Consensus (2017), 95.7% of experts recommended SLNB for cN0 patients receiving NAC, but the opinions were not consistent for the optimal time of SLNB and NAC.…”

Section: Discussionmentioning

confidence: 99%

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Neo‐adjuvant chemotherapy and axillary de‐escalation management for patients with clinically node‐negative breast cancer

et al. 2019

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This study aimed to explore the optimal time of sentinel lymph node biopsy (SLNB) and neo‐adjuvant chemotherapy (NAC) and to assess the feasibility of selective elimination of axillary surgery after NAC in clinically node‐negative (cN0) patients. From April 2010 to August 2018, 845 patients undergoing surgery after NAC were included in this retrospective study to analyze the correlation between different clinicopathological characteristics of cN0 patients and negative axillary lymph node after NAC (ypN0). Among the 148 cN0 patients, 83.1% (123/148) were ypN0. The rates of ypN0 in patients with hormone receptor positive (HR+)/HER2−, HR+/HER2+, HR−/HER2+, and triple‐negative (TN) breast cancer were 75.4% (46/61), 82.6% (19/23), 85.2% (23/27), and 94.6% (35/37), respectively (P < 0.001). The rates of ypN0 in TN and HER2+ patients were 94.6% and 95.5%, which were significantly higher than that in HR+/HER2− patients (P < 0.05). Molecular subtypes, clinical stage, radiologic complete response, and pathologic complete response (bpCR) of the breast tumor correlated with ypN0 after full‐course NAC (P < 0.05). Molecular subtypes (OR = 2.374, P = 0.033), clinical stage (OR = 0.320, P = 0.029), and bpCR (OR = 0.454, P = 0.012) were independent predictors for ypN0. The optimal time of SLNB and NAC in cN0 patients might be different among different molecular subtypes: it would be preferable to perform SLNB prior to NAC for HR+/HER2− patients, and SLNB after NAC for TN and HER2+ patients to reduce the risk of axillary lymph node dissection. In view of the high ypN0 rate in cN0 patients, axillary surgical staging might be selectively eliminated, especially for HER2+ and TN patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Neo‐adjuvant chemotherapy and axillary de‐escalation management for patients with clinically node‐negative breast cancer

et al. 2019

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“…Patients were eligible for inclusion in the study if they had received 1 of 4 surgical treatments consistent with clinical practice guidelines within 6 months of the initial diagnosis: BLM, ULM, or breast-conserving treatment consisting of breastconserving surgery (BCS) with radiotherapy (BCT) 16 ; in women aged ≥70 years with AJCC stage I, hormone receptor-positive, and human epidermal growth factor receptor 2 (HER2)-negative breast cancer, BCS without radiotherapy also was included because this treatment is consistent with practice guidelines for such patients. 16 Women who received non-guideline-concordant surgical treatment were excluded from the analysis because they were considered to be nonrepresentative of the standard of care. Neighborhood socioeconomic status was measured using patients' residential census block group at the time of diagnosis using an established multicomponent scale.…”

Section: Methodsmentioning

confidence: 99%

Magnitude of reduction in risk of second contralateral breast cancer with bilateral mastectomy in patients with breast cancer: Data from California, 1998 through 2015

Kurian

Canchola

Cindy

et al. 2019

Cancer

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Background Increasingly, patients with breast cancer undergo bilateral mastectomy (BLM). To the authors' knowledge, the magnitude of benefit is unknown. Methods The authors used data from the Surveillance, Epidemiology, and End Results (SEER) program regarding all women diagnosed with American Joint Committee on Cancer stage 0 to stage III unilateral breast cancer in California from 1998 through 2015 and treated with BLM versus breast‐conserving therapy including surgery and radiotherapy (BCT) or unilateral mastectomy (ULM). The authors measured relative risks of second contralateral breast cancer (CBC) and breast cancer death using Fine and Gray multivariable regression modeling adjusted for the competing risk of death and death from another cause, respectively, and potential confounding factors. Absolute excess risk of CBC was measured as the observed minus expected number of breast cancers in the general population divided by 10,000 person‐years at risk. Results Among 245,418 patients with a median follow‐up of 6.7 years, 7784 patients (3.2%) developed CBC. Relative risks were lower after BLM (hazard ratio [HR], 0.10; 95% CI, 0.07‐0.14) and higher after ULM (HR, 1.07; 95% CI, 1.02‐1.13) versus BCT. Absolute excess risks were higher after BCT and ULM (5.0 and 13.6 more cases, respectively) compared with BLM (28.6 fewer cases). BLM reduced risk more among older women (38.0 fewer cases for women aged ≥50 years vs 17.9 fewer cases among women aged <50 years) but provided similar risk reduction across categories of tumor grade and tumor hormone receptor status. Compared with BCT, the risk of breast cancer death was equivalent after BLM (HR, 1.03; 95% CI, 0.96‐1.11) and higher after ULM (HR, 1.21; 95% CI, 1.17‐1.25). Conclusions BLM may reduce second breast cancer risk by 34 to 43 cases per 10,000 person‐years compared with other surgical procedures, but is not associated with a lower risk of death. Second breast cancers are rare, and their reduction should be weighed against the harms associated with BLM.

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“…Selection of treatment is mainly based on four factors: the extent of disease, prior response to adjuvant endocrine therapy, the patient's clinical status, and patient preference . As per major international guidelines, endocrine therapy is regarded as the cornerstone treatment for HR+/HER2− advanced BC and should be considered for the majority of patients with locally advanced or metastatic tumors, with exceptions for those with life‐threatening disease, those experiencing visceral crisis, or those with prior endocrine resistance …”

Section: Introductionmentioning

confidence: 99%

Fulvestrant in the treatment of hormone receptor‐positive/human epidermal growth factor receptor 2‐negative advanced breast cancer: A review

Wang

Shao

2019

Cancer Medicine

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Nearly 75% of breast cancers are hormone receptor‐positive (HR+) and human epidermal growth factor receptor type 2‐negative (HER2−), making endocrine therapy the mainstay of treatment for HR+ and HER2− combination. Although endocrine therapy, such as therapy with fulvestrant, is widely used in the clinic, endocrine resistance (primary or secondary) is inevitable and poses a serious clinical concern. However, the therapeutic landscape of HR+/HER2− breast cancer is rapidly changing and evolving. In recent years, molecular insights into the genome of HR+/HER2− breast cancer have helped to identify promising targets, such as alterations in signaling pathways [phosphatidylinositide 3‐kinase (PI3K/AKT/mammalian target of rapamycin (mTOR)], dysregulation of the cell cycle (CDK4/6), and identification of new ESR1 mutations. These insights have led to the development of newer targeted therapies, which aims at significantly improving survival in these patients. This review summarizes the role and rationale of fulvestrant when used as a monotherapy or in combination with targeted therapies in patients with HR+/HER2− advanced breast cancer. We also discuss other novel agents and potential future combination treatment options.

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Breast Cancer, Version 4.2017, NCCN Clinical Practice Guidelines in Oncology

Cited by 489 publications

References 4,936 publications

Neo‐adjuvant chemotherapy and axillary de‐escalation management for patients with clinically node‐negative breast cancer

Neo‐adjuvant chemotherapy and axillary de‐escalation management for patients with clinically node‐negative breast cancer

Magnitude of reduction in risk of second contralateral breast cancer with bilateral mastectomy in patients with breast cancer: Data from California, 1998 through 2015

Fulvestrant in the treatment of hormone receptor‐positive/human epidermal growth factor receptor 2‐negative advanced breast cancer: A review

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