NCCN Guidelines Insights: Breast Cancer, Version 3.2018

Featured Updates to the NCCN Guidelines

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These NCCN Guidelines Insights highlight the updated recommendations for use of multigene assays to guide decisions on adjuvant systemic chemotherapy therapy for women with hormone receptor–positive, HER2-negative early-stage invasive breast cancer. This report summarizes these updates and discusses the rationale behind them.

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  • 1.

    Siegel RL, Miller KD, Jemal A. Cancer statistics, 2019. CA Cancer J Clin 2019;69:7–34.

  • 2.

    Berry DA, Cirrincione C, Henderson IC, . Estrogen-receptor status and outcomes of modern chemotherapy for patients with node-positive breast cancer. JAMA 2006;295:1658–1667.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3.

    Paik S, Shak S, Tang G, . A multigene assay to predict recurrence of tamoxifen-treated, node-negative breast cancer. N Engl J Med 2004;351:2817–2826.

  • 4.

    Dowsett M, Cuzick J, Wale C, . Prediction of risk of distant recurrence using the 21-gene recurrence score in node-negative and node-positive postmenopausal patients with breast cancer treated with anastrozole or tamoxifen: a TransATAC study. J Clin Oncol 2010;28:1829–1834.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5.

    Mamounas EP, Tang G, Fisher B, . Association between the 21-gene recurrence score assay and risk of locoregional recurrence in node-negative, estrogen receptor-positive breast cancer: results from NSABP B-14 and NSABP B-20. J Clin Oncol 2010;28:1677–1683.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6.

    Albain KS, Barlow WE, Shak S, . Prognostic and predictive value of the 21-gene recurrence score assay in postmenopausal women with node-positive, oestrogen-receptor-positive breast cancer on chemotherapy: a retrospective analysis of a randomised trial. Lancet Oncol 2010;11:55–65.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7.

    Paik S, Tang G, Shak S, . Gene expression and benefit of chemotherapy in women with node-negative, estrogen receptor-positive breast cancer. J Clin Oncol 2006;24:3726–3734.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8.

    Tang G, Shak S, Paik S, . Comparison of the prognostic and predictive utilities of the 21-gene Recurrence Score assay and Adjuvant! for women with node-negative, ER-positive breast cancer: results from NSABP B-14 and NSABP B-20. Breast Cancer Res Treat 2011;127:133–142.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9.

    Sparano JA, Gray RJ, Makower DF, . Adjuvant chemotherapy guided by a 21-gene expression assay in breast cancer. N Engl J Med 2018;379:111–121.

  • 10.

    Nitz U, Gluz O, Christgen M, . Reducing chemotherapy use in clinically high-risk, genomically low-risk pN0 and pN1 early breast cancer patients: five-year data from the prospective, randomised phase 3 West German Study Group (WSG) PlanB trial. Breast Cancer Res Treat 2017;165:573–583.

    • Search Google Scholar
    • Export Citation
  • 11.

    Stemmer SM, Steiner M, Rizel S, . Clinical outcomes in ER+ HER2-node-positive breast cancer patients who were treated according to the recurrence score results: evidence from a large prospectively designed registry. NPJ Breast Cancer 2017;3:32.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 12.

    Cardoso F, van’t Veer LJ, Bogaerts J, . 70-gene signature as an aid to treatment decisions in early-stage breast cancer. N Engl J Med 2016;375:717–729.

  • 13.

    Dowsett M, Sestak I, Lopez-Knowles E, . Comparison of PAM50 risk of recurrence score with oncotype DX and IHC4 for predicting risk of distant recurrence after endocrine therapy. J Clin Oncol 2013;31:2783–2790.

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    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14.

    Lænkholm AV, Jensen MB, Eriksen JO, . PAM50 risk of recurrence score predicts 10-year distant recurrence in a comprehensive Danish cohort of postmenopausal women allocated to 5 years of endocrine therapy for hormone receptor-positive early breast cancer. J Clin Oncol 2018;36:735–740.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 15.

    Sestak I, Buus R, Cuzick J, . Comparison of the performance of 6 prognostic signatures for estrogen receptor–positive breast cancer: a secondary analysis of a randomized clinical trial. JAMA Oncol 2018;4:545–553.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16.

    Filipits M, Rudas M, Jakesz R, . A new molecular predictor of distant recurrence in ER-positive, HER2-negative breast cancer adds independent information to conventional clinical risk factors. Clin Cancer Res 2011;17:6012–6020.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17.

    Ma XJ, Wang Z, Ryan PD, . A two-gene expression ratio predicts clinical outcome in breast cancer patients treated with tamoxifen. Cancer Cell 2004;5:607–616.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18.

    Goetz MP, Suman VJ, Ingle JN, . A two-gene expression ratio of homeobox 13 and interleukin-17B receptor for prediction of recurrence and survival in women receiving adjuvant tamoxifen. Clin Cancer Res 2006;12:2080–2087.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19.

    Ma XJ, Hilsenbeck SG, Wang W, . The HOXB13:IL17BR expression index is a prognostic factor in early-stage breast cancer. J Clin Oncol 2006;24:4611–4619.

  • 20.

    Jansen MP, Sieuwerts AM, Look MP, . HOXB13-to-IL17BR expression ratio is related with tumor aggressiveness and response to tamoxifen of recurrent breast cancer: a retrospective study. J Clin Oncol 2007;25:662–668.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21.

    Ma XJ, Salunga R, Dahiya S, . A five-gene molecular grade index and HOXB13:IL17BR are complementary prognostic factors in early stage breast cancer. Clin Cancer Res 2008;14:2601–2608.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22.

    Sgroi DC, Sestak I, Cuzick J, . Prediction of late distant recurrence in patients with oestrogen-receptor-positive breast cancer: a prospective comparison of the breast-cancer index (BCI) assay, 21-gene recurrence score, and IHC4 in the TransATAC study population. Lancet Oncol 2013;14:1067–1076.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
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