Metastatic Breast Cancer, Version 1.2012

Featured Updates to the NCCN Guidelines

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These NCCN Guidelines Insights highlight the important updates/changes specific to the management of metastatic breast cancer in the 2012 version of the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Breast Cancer. These changes/updates include the issue of retesting of biomarkers (estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2) on recurrent disease, new information regarding first-line combination endocrine therapy for metastatic disease, a new section on monitoring of patients with metastatic disease, and new information on endocrine therapy combined with an mTOR inhibitor as a subsequent therapeutic option.

  • 1

    Siegel R, Naishadham D, Jemal A. Cancer statistics, 2012. CA Cancer J Clin 2012;62:1029.

  • 2

    Allred DC, Carlson RW, Berry DA. NCCN Task Force Report: estrogen receptor and progesterone receptor testing in breast bancer by immunohistochemistry. J Natl Compr Canc Netw 2009;7(Suppl 6):S121.

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  • 3

    Hammond ME, Hayes DF, Dowsett M. American Society of Clinical Oncology/College of American Pathologists guideline recommendations for immunohistochemical testing of estrogen and progesterone receptors in breast cancer. J Clin Oncol 2010;28:27842795.

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  • 4

    Carlson RW, Moench SJ, Hammond ME. HER2 testing in breast cancer: NCCN Task Force report and recommendations. J Natl Compr Canc Netw 2006;4(Suppl 3):S122.

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  • 5

    Wolff AC, Hammond ME, Schwartz JN. American Society of Clinical Oncology/College of American Pathologists guideline recommendations for human epidermal growth factor receptor 2 testing in breast cancer. J Clin Oncol 2007;25:118145.

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  • 6

    Bogina G, Bortesi L, Marconi M. Comparison of hormonal receptor and HER-2 status between breast primary tumours and relapsing tumours: clinical implications of progesterone receptor loss. Virchows Arch 2011;459:110.

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  • 7

    Fabi A, Di Benedetto A, Metro G. HER2 protein and gene variation between primary and metastatic breast cancer: significance and impact on patient care. Clin Cancer Res 2011;17:20552064.

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  • 8

    Karlsson E, Lindström LS, Wilking U. Discordance in hormone receptor status in breast cancer during tumor progression [abstract]. J Clin Oncol 2010;28:(Suppl):Abstract 1009.

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  • 9

    Sari E, Guler G, Hayran M. Comparative study of the immunohistochemical detection of hormone receptor status and HER-2 expression in primary and paired recurrent/metastatic lesions of patients with breast cancer. Med Oncol 2011;28:5763.

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  • 10

    Simmons C, Miller N, Geddie W. Does confirmatory tumor biopsy alter the management of breast cancer patients with distant metastases? Ann Oncol 2009;20:14991504.

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  • 11

    Gong Y, Booser DJ, Sneige N. Comparison of HER-2 status determined by fluorescence in situ hybridization in primary and metastatic breast carcinoma. Cancer 2005;103:17631769.

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  • 12

    Tapia C, Savic S, Wagner U. HER2 gene status in primary breast cancers and matched distant metastases. Breast Cancer Res 2007;9:R31.

  • 13

    Bergh J, Jönsson P, Lidbrink E. First results from FACT – an open-label, randomized phase III study investigating loading dose of fulvestrant combined with anastrozole versus anastrozole at first relapse in hormone receptor positive breast cancer [abstract]. Cancer Res 2009;69(24 Suppl):Abstract 23.

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  • 14

    Mehta R, Barlow W, Albain K. A Phase III randomized trial of anastrozole versus anastrozole and fulvestrant as first-line therapy for postmenopausal women with metastatic breast cancer: SWOG S0226 [abstract]. Presented at the 34th Annual San Antonio Breast Cancer Symposium; December 6–10, 2011; San Antonio, Texas. Abstract 1.

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  • 15

    Eisenhauer EA, Therasse P, Bogaerts J. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer 2009;45:228247.

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  • 16

    Miller AB, Hoogstraten B, Staquet M, Winkler A. Reporting results of cancer treatment. Cancer 1981;47:207214.

  • 17

    Baselga J, Campone M, Piccart M. Everolimus in postmenopausal hormone-receptor-positive advanced breast cancer. N Engl J Med 2012;366:520529.

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  • 18

    Chow L, Sun Y, Jassem J. Phase 3 study of temsirolimus with letrozole or letrozole alone in postmenopausal women with locally advanced or metastatic breast cancer [abstract]. Presented at the 29th Annual San Antonio Breast Cancer Symposium; December 14–17, 2006; San Antonio, Texas. Abstract 6091.

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