NCCN VERSION 2 2015

NCCN Guidelines Version 2.2015 Invasive Breast Cancer

NCCN Guidelines Index Breast Cancer Table of Contents Discussion

SYSTEMIC ADJUVANT TREATMENT - FAVORABLE HISTOLOGIES

No adjuvant therapy cc Consider adjuvant endocrine therapy w Adjuvant endocrine therapy w Adjuvant endocrine therapy w ± adjuvant chemotherapy x,y

<1 cm

pT1, pT2, or pT3; and pN0 or pN1mi (≤2 mm axillary node metastasis)

1–2.9 cm

ER-positive and/or PR-positive

≥3 cm

Node positive (one or more metastases >2 mm to one or more ipsilateral axillary lymph nodes)

Histology: • Tubular • Mucinous

See Follow-Up (BINV-16)

ER-positive and/or PR-positive

Follow appropriate pathway above

ER-negative and PR-negative

Repeat determination of ER/PR status

ER-negative and PR-negative

Treat as usual breast cancer histology ( See BINV-7 and BINV-8 )

See Adjuvant Endocrine Therapy (BINV-J) and Neoadjuvant/Adjuvant Chemotherapy (BINV-K)

w Evidence supports that the magnitude of benefit from surgical or radiation ovarian ablation in premenopausal women with hormone receptor-positive breast cancer is similar to that achieved with CMF alone. Early evidence suggests similar benefits from ovarian suppression (ie, LHRH agonist) as from ovarian ablation. The combination of ovarian ablation/suppression plus endocrine therapy may be superior to suppression alone. The benefit of ovarian ablation/suppression in premenopausal women who have received adjuvant chemotherapy is uncertain. x Chemotherapy and endocrine therapy used as adjuvant therapy should be given sequentially with endocrine therapy following chemotherapy. Available data suggest that sequential or concurrent endocrine therapy with radiation therapy is acceptable. y There are limited data to make chemotherapy recommendations for those >70 y old. Treatment should be individualized with consideration of comorbid conditions. cc If ER-positive, consider endocrine therapy for risk reduction and to diminish the small risk of disease recurrence.

Note: All recommendations are category 2A unless otherwise indicated. Clinical Trials: NCCN believes that the best management of any cancer patient is in a clinical trial. Participation in clinical trials is especially encouraged.

BINV-9

Version2.2015, 03/11/2015© National Comprehensive Cancer Network, Inc. 2015,All rights reserved.The NCCN Guidelines ® and this illustration may not be reproduced in any form without the express written permission of NCCN ® .