- RECOMMENDED CITATION FOR NCCN GUIDELINES USING ZOTERO TRIAL
- RECOMMENDED CITATION FOR NCCN GUIDELINES USING ZOTERO PLUS
“There is no excuse for radiation oncologists not to adopt hypofractionation,” said Dr. The NCCN panel now recommends that whole-breast RT be delivered by hypofractionation, a shorter treatment course that uses larger doses per fraction. Hypofractionation as Preferred RT Strategy “Obviously, these data are in some ways very compelling, but we must individualize our choices,” Dr. The findings suggest that ovarian suppression with an AI (exemestane was more effective than tamoxifen) may be appropriate in higher-risk patients however, musculoskeletal issues and complaints related to estrogen deprivation can be problematic. In the joint analysis of these trials ( Figure 1), this strategy improved all end points but overall survival.
RECOMMENDED CITATION FOR NCCN GUIDELINES USING ZOTERO PLUS
Recently, the SOFT and TEXT trials have confirmed the benefit of ovarian suppression plus endocrine therapy (± chemotherapy). More than half of breast cancer recurrences happen after discontinuation of treatment, 2 and ovarian suppression or ablation is a way of protecting against these late recurrences. Those who become postmenopausal can consider 5 more years of tamoxifen or switch to an AI for 5 years. Women who remain premenopausal can consider tamoxifen for another 5 years (10 total) or no further endocrine therapy. For premenopausal women at diagnosis, the NCCN Guidelines for Breast Cancer suggest tamoxifen for 5 years, with or without ovarian suppression, or an AI for 5 years combined with ovarian suppression or ablation (category 1).
RECOMMENDED CITATION FOR NCCN GUIDELINES USING ZOTERO TRIAL
Subtle changes have been made in the recommendations for adjuvant endocrine therapy, reflecting recent trial data. Although pCR is associated with improved outcomes in patients with ER-negative disease, it does not appreciably impact outcomes in those with ER-positive disease, he said. The achievement of pathologic complete response (pCR) is not especially critical with preoperative endocrine therapy, Dr. “While this is mainly used in postmenopausal women, you can treat premenopausal women with aromatase inhibitors as long as you render them postmenopausal with ovarian suppression or ablation first.” “Adjuvant endocrine therapy is a rational approach,” he said. After 16 weeks of preoperative exemestane, letrozole, or anastrozole, response or stable disease was observed in 60%, 72%, and 68% of patients, respectively. Gradishar referred to ACOSOG Z1031 to show the benefit of neoadjuvant endocrine therapy. Although most of these patients will be postmenopausal, this approach can be considered in premenopausal women with concerns that make them unsuitable for or undesiring of chemotherapy, according to Dr. Appropriate candidates are patients with estrogen receptor (ER)–rich tumors (Allred 7–8).
She also discussed issues related to regional nodal irradiation.įor preoperative systemic therapy, the NCCN Guidelines were modified to include the selective use of endocrine therapy. Salerno presented updates in locoregional treatment and emphasized the benefits of hypofractionated whole-breast radiation therapy (RT). Gradishar discussed medical management, focusing on endocrine therapy in the neoadjuvant, adjuvant, and metastatic settings the benefit of ovarian suppression preoperative HER2-directed therapy and fertility preservation.ĭr. Salerno, MD, Assistant Professor, Radiation Oncology, and Director of Breast Radiation and Soft Tissue/Melanoma Radiation, Roswell Park Cancer Institute, and a member of the NCCN Breast Cancer Panel.ĭr. However, they were called “important tweaks” by Dr. Updates to the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Breast Cancer were relatively minor, according to William Gradishar, MD, the Betsy Bramsen Professor of Breast Oncology at the Feinberg School of Medicine, Northwestern University, and Chair of the NCCN Breast Cancer Guidelines Panel.
Important “Tweaks” in Early-Stage Breast Cancer Guidelines
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