The National Comprehensive Cancer Network (NCCN) recently held its 15th Annual Conference in Hollywood, Florida. The conference was entitled “Clinical Practice Guidelines & Quality Cancer Care” and included multiple presentations with updates to the NCCN Guidelines. Below, we cover updates to the NCCN Guidelines for breast cancer, acute myeloid leukemia, and multiple myeloma. To view the complete NCCN Guidelines, go to www.nccn.org.
NCCN Breast Cancer Guidelines Updates
At the National Comprehensive Cancer Network (NCCN) 15th Annual Meeting, Robert W. Carlson, MD, chair of the NCCN Breast Cancer Panel Members and professor of medicine in the Division of Oncology at Stanford Comprehensive Cancer Center, reviewed changes to the NCCN Breast Cancer Guidelines for invasive breast cancer. Major changes were made to protocols regarding the initial workup and evaluation of patients, as well as the administration of local therapy, adjuvant systemic therapy, and systemic therapy for metastatic disease.
NCCN’s updated guidelines now recommend offering genetic counseling to patients at high risk for hereditary breast cancer during their initial evaluation. In addition, PET/CT scanning, which combines the molecular/functional imaging of FDG-PET with the anatomical imaging of CT scanning, was added as optional study to supplement bone and CT scanning; this is a category 2B recommendation. Carlson noted that FDG PET/CT is most useful in cases where standard staging studies yield suspicious or unequivocal findings, especially in the setting of locally advanced or metastatic disease, noting it may identify unsuspected regional or distant metastasis, though biopsy in these cases may ultimately prove more useful. He also cautioned that “the use of PET or PET/CT scanning is not indicated in the staging of clinical stage I, II, or operable stage III disease.”
The updated guidelines call for limiting the staging of clinically negative axilla to sentinel lymph node (SNL) biopsy, which according to the literature identifies more than 95% of SNLs accurately and has a less than 10% false-negative rate. In addition, it has a high prognostic value and low rate of complications, with less than 1% of women with negative SNLs experiencing axillary recurrence and only 7% experiencing lymph edema. One drawback to this recommendation is that SNL biopsy may not readily be available in certain parts of the United States or in some of the countries that are seeking to adopt the NCCN guidelines.
Adjuvant Systemic Therapy
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