NCCN Guidelines® Insights: Breast Cancer, Version 4.2021

Abstract

The NCCN Guidelines for Breast Cancer include up-to-date guidelines for clinical management of patients with carcinoma in situ, invasive breast cancer, Paget disease, phyllodes tumor, inflammatory breast cancer, male breast cancer, and breast cancer during pregnancy. These guidelines are developed by a multidisciplinary panel of representatives from NCCN Member Institutions with breast cancer–focused expertise in the fields of medical oncology, surgical oncology, radiation oncology, pathology, reconstructive surgery, and patient advocacy. These NCCN Guidelines Insights focus on the most recent updates to recommendations for adjuvant systemic therapy in patients with nonmetastatic, early-stage, hormone receptor–positive, HER2-negative breast cancer.

Immune Checkpoint Inhibitors Combined With Chemotherapy Compared With Chemotherapy Alone for Triple-Negative Breast Cancer: A Systematic Review and Meta-Analysis

“…Due to the lack of targets for therapeutic intervention, the treatment of TNBC is challenging ( 23 ). Whether immunotherapy can improve the curative effect when added to original standard chemotherapy treatment is still controversial ( 7 , 8 ). This meta-analysis first compared ICI+chemotherapy with chemotherapy for TNBC treatment.…”

“…In the updated guidelines, ICIs+chemotherapy has been recognized as one of the treatment options for TNBC ( 7 , 8 ). The KEYNOTE-522 and IMpassion130 trials compared ICIs+chemotherapy with chemotherapy in 2,076 patients with TNBC and suggested that combination therapy prolonged progression-free survival (PFS) and increased the rates of pathological complete response (PCR) ( 9 , 10 ).…”

A Three lncRNA Set: AC009975.1, POTEH-AS1 and AL390243.1 as Nodal Efficacy Biomarker of Neoadjuvant Therapy for HER-2 Positive Breast Cancer

“…For patients with initial cN + and ycN 0 disease after NAT, the feasibility of SLNB has been confirmed by NCCN guidelines (category 2B) and St. Gallen international expert consensus (5,6,8). However, the overall FNR of patients undergoing SLNB after NAT is still high.…”

“…At the same time, identification of apCR and subsequent omission of ALND could prevent the short- and long-term side effects of ALND such as lymph edema, limited range of motion of the shoulder, and numbness of the upper arm ( 4 ). In the era of sentinel lymph node biopsy (SLNB), the feasibility of SLNB has been confirmed in selected cases (category 2B) for patients with initial cN + and ycN 0 disease after NAT ( 5 , 6 ). The result of the Z1071 trial showed that for patients with initial cN + and ycN 0 disease after NAT, using combined tracers (radiolabeled colloid and blue dye) and detecting > 2 negative sentinel lymph nodes (SLN), the false negative rate (FNR) of SLNB after NAT could reduce to 10% or less ( 7 ).…”

Personalising therapy for early-stage oestrogen receptor-positive breast cancer in older women

“… 47 , 48 Recent evidence has led to refining the diagnostic utility of SLNB, especially in older women. 49 – 51 The Society of Surgical Oncology advocates for omission of SLNB in women aged 70 years or older with early-stage ER+, HER2− breast cancer. 23 A large cohort study of more than 3000 older women, aged 70 years and older, at a single health-care system revealed that performing SLNB in this subgroup provided no outcome advantages with respect to locoregional recurrence or breast cancer-specific survival.…”