NCCN Guidelines Updates: Breast Cancer

Abstract

The emergence of CDK4/6 inhibitors has changed the treatment algorithm for advanced/metastatic estrogen receptor-positive breast cancer. In pivotal trials of palbociclib, ribociclib, and abemaciclib, doubling in progression-free survival has been seen. All 3 agents in this class are now included in the NCCN Guidelines for Breast Cancer, and clinicians should be incorporating these agents into their treatment algorithms. The other important issue in this breast cancer setting is extended duration of endocrine therapy. Most of the benefit is modest and toxicity is an issue; therefore, extended-duration endocrine therapy should be highly individualized. For triple-negative disease, platinum agents and PARP inhibitors are helping some patients, but immunotherapies and other novel classes of drugs now in development hold the promise of even better outcomes. In HER2-positive early-stage disease, dual HER2 blockade is of modest benefit, and extended treatment with neratinib may be a good option for some high-risk patients.

Neoadjuvant Treatment in Patients With Resectable and Borderline Resectable Pancreatic Cancer

“…Commonly used criteria include the NCCN guidelines (15,16), MD Anderson Cancer Center (MDACC) guidelines (11,12), the AHPBA/SSAT/SSO expert consensus guidelines (13), and the International Study Group of Pancreatic Surgery (ISGPS) criteria (14). The 2013 NCCN guidelines adopted the ISGPS criteria, and minor modifications were made in the following NCCN guidelines.…”

“…The NCCN guideline, ASCO Clinical Practice Guideline, and European Society for Medical Oncology (ESMO) Clinical Practice Guideline are commonly used guidelines for pancreatic cancer treatment (15,21,58,59). Due to the lack of large RCTs for neoadjuvant treatment of PDAC, most recommendations in these guidelines are based on systematic reviews of cohort studies, providing Oxford Levels of Evidence category 2A (60).…”

CDK4/6 Inhibitors for Advanced Hormone Receptor–Positive Breast Cancer, 2019 and Beyond

“…CDK4/6 inhibitor therapy in combination with aromatase inhibitors (AIs) and the selective estrogen receptor degrader fulvestrant have demonstrated efficacy for postmenopausal women. 1 Further data support use of ribociclib in premenopausal women and abemaciclib monotherapy for heavily pretreated patients. 1 The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) now list regimens including a CDK4/6 inhibitor in combination with an AI or fulvestrant as preferred treatment options in patients with metastatic HR1, HER2-negative breast cancer.…”

Current Status and Future Perspectives of Axillary Management in the Neoadjuvant Setting

“…There is still some debate regarding the clinical significance of SLNB performed before or after NACT, which may explain different recommendations in international guidelines. SLNB after NACT is the preferred procedure according to the NCCN and the German S3 and AGO guidelines [5,6,7]. In contrast, in Sweden, SLNB is recommended before NACT [8].…”