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Metastatic Breast Cancer, Version 1.2012

Featured Updates to the NCCN Guidelines

Robert W. Carlson, D. Craig Allred, Benjamin O. Anderson, Harold J. Burstein, Stephen B. Edge, William B. Farrar, Andres Forero, Sharon Hermes Giordano, Lori J. Goldstein, William J. Gradishar, Daniel F. Hayes, Clifford A. Hudis, Steven Jay Isakoff, Britt-Marie E. Ljung, David A. Mankoff, P. Kelly Marcom, Ingrid A. Mayer, Beryl McCormick, Lori J. Pierce, Elizabeth C. Reed, Mary Lou Smith, Hatem Soliman, George Somlo, Richard L. Theriault, John H. Ward, Antonio C. Wolff, Richard Zellars, Rashmi Kumar, and Dorothy A. Shead

adjuvant tamoxifen experienced the greatest benefit with the combination endocrine therapy. The reason for the divergent outcomes in the 2 studies is not known. NCCN Guidelines Insights : Metastatic Breast Cancer, Version 1.2012 Version 1

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Nikhil Khandelwal, Ian Duncan, Tamim Ahmed, Elan Rubinstein, and Cheryl Pegus

cohort completed the 5-year course of tamoxifen treatment. A recent survey of managed care organizations showed that approximately 45% of oral chemotherapy is dispensed through retail pharmacy channels, 31% through specialty pharmacies, 16% through mail

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Annika M. Gustafson, Deborah J. Goldfrank, William A. Dunson, Daniel L. Mulkerin, Rebecca L. Caires, and Keith D. Eaton

can result in lowered IQ and fetal malformation, depending on gestational age of the fetus and exposure level. 6 Hormonal treatments such as tamoxifen can result in a high frequency of congenital abnormalities, requiring the use of reliable birth

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Laura Spring, Rachel Greenup, Andrzej Niemierko, Lidia Schapira, Stephanie Haddad, Rachel Jimenez, Suzanne Coopey, Alphonse Taghian, Kevin S. Hughes, Steven J. Isakoff, Leif W. Ellisen, Barbara L. Smith, Michelle Specht, Beverly Moy, and Aditya Bardia

population suggesting very young women (age <35 years) are less likely to benefit from adjuvant hormone therapy, perhaps due to de novo tamoxifen resistance, highlighting the need to develop better therapies for this population. 6 Based on the results of the

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Benjamin E. Greer, Wui-Jin Koh, Nadeem Abu-Rustum, Michael A. Bookman, Robert E. Bristow, Susana M. Campos, Kathleen R. Cho, Larry Copeland, Marta Ann Crispens, Patricia J. Eifel, Warner K. Huh, Wainwright Jaggernauth, Daniel S. Kapp, John J. Kavanagh, John R. Lurain III, Mark Morgan, Robert J. Morgan Jr, C. Bethan Powell, Steven W. Remmenga, R. Kevin Reynolds, Angeles Alvarez Secord, William Small Jr, and Nelson Teng

– 1744 . 79 Quinn MA Campbell JJ . Tamoxifen therapy in advanced/recurrent endometrial carcinoma . Gynecol Oncol 1989 ; 32 : 1 – 3 . 80 Thigpen T Brady MF Homesley HD . Tamoxifen in the treatment of advanced or recurrent

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Donna Trauth and Lori J. Goldstein

. Effects of radiotherapy and surgery in early breast cancer – An overview of the randomized trials . N Engl J Med 1995 ; 333 : 1444 – 1456 . 2 Early Breast Cancer Trialists'Collaborative Group . Effects of adjuvant tamoxifen and of cytotoxic

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Julia C. Shih and Anthony J. Olszanski

. 6 Within cancer care, the earliest reports of nonadherence rates were documented in breast cancer with endocrine therapies, ranging from 12% to 59% with tamoxifen and 9% to 50% with aromatase inhibitors. 7 In a systematic review by Greer et al, 1

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Joyce Liu and Ursula Matulonis

Carrasco EM . Tamoxifen therapy for ovarian cancer in the adjuvant and advanced settings: systematic review of the literature and implications for future research . Gynecol Oncol 2002 ; 84 : 201 – 209 . 45. del Carmen MG Fuller AF Matulonis

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Puyao C. Li, Zilu Zhang, Angel M. Cronin, and Rinaa S. Punglia

the EORTC Breast Cancer Cooperative Group and EORTC Radiotherapy Group . J Clin Oncol 2006 ; 24 : 3381 – 3387 . 16801628 2. Houghton J , George WD , Cuzick J , . Radiotherapy and tamoxifen in women with completely excised ductal carcinoma

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James O. Armitage, William C. Wood, and Dan L. Longo

-conserving surgery plus radiation therapy in DCIS are available. Several studies compare local excision to local excision plus whole-breast radiation (with or without tamoxifen), 9 and all showed improved local control with the addition of whole-breast radiation