NCCN Guidelines® Insights: Breast Cancer, Version 4.2023

Abstract

The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Breast Cancer address all aspects of management for breast cancer. The treatment landscape of metastatic breast cancer is evolving constantly. The therapeutic strategy takes into consideration tumor biology, biomarkers, and other clinical factors. Due to the growing number of treatment options, if one option fails, there is usually another line of therapy available, providing meaningful improvements in survival. This NCCN Guidelines Insights report focuses on recent updates specific to systemic therapy recommendations for patients with stage IV (M1) disease.

Discordance of Biomarker Expression Profile between Primary Breast Cancer and Synchronous Axillary Lymph Node Metastasis in Preoperative Core Needle Biopsy

“…Therefore, tumor cells from metastatic foci often exhibit a different biomarker expression profile than PTs, reflecting the progressive acquisition of mutations in key oncogenes and tumor suppressor genes [26]. Thus, both the National Comprehensive Cancer Network (NCCN) [27] and ASCO [28] suggest repeating surrogate immunohistochemical and/or molecular tests in newly detected metastases to find relevant differences from PTs that are able to influence therapeutic strategies. Likewise, intratumoral heterogeneity explains why neoplastic cells in metastatic ALNs could better represent the biological potential of the whole disease than those in PTs [13].…”

Nipple Lesions of the Breast

“…In particular, MRI detected mammographically-occult disease in 4 of 8 patients. Accordingly, the current NCCN guidelines suggest MRI examination in the setting of MPD with negative mammography and ultrasound studies 66 . In the setting of clinical suspicion of MPD with no imaging evidence of underlying disease, it is recommended to obtain a full-thickness skin biopsy of the involved nipple-areolar lesion, whereas if mammographic, ultrasound, or MRI examination detects a suspicious area in the breast, core biopsy of breast lesion and full-thickness skin biopsy of the involved NAC should be obtained to rule out multifocal disease, which would require a mastectomy.…”

Prevalence and Predictive Factors of Neutropenia Among Patients With Breast Cancer Receiving Doxorubicincyclophosphamide Chemotherapy at a Cancer Center, Surin Hospital: A Retrospective Case-Control Study

“…Nowadays, the treatment of breast cancer has advanced significantly with targeted therapy and immunotherapy. (1) However, chemotherapy, mainly an anthracycline-based regimen, remains the cornerstone and is widely utilized across all stages of breast cancer. (1,2) Nevertheless, certain complications may arise following this treatment, including nausea, vomiting, fatigue, hair loss, mouth sores, and bone marrow suppression, (3) leading to cytopenia and potentially resulting in life-threatening complications such as febrile neutropenia.…”

“…(1) However, chemotherapy, mainly an anthracycline-based regimen, remains the cornerstone and is widely utilized across all stages of breast cancer. (1,2) Nevertheless, certain complications may arise following this treatment, including nausea, vomiting, fatigue, hair loss, mouth sores, and bone marrow suppression, (3) leading to cytopenia and potentially resulting in life-threatening complications such as febrile neutropenia. (4) In a literature review conducted by Alexandre Chan and colleagues on the 'Incidence of febrile neutropenia among early-stage breast cancer patients receiving anthracycline-based chemotherapy,' it was discovered that early-stage breast cancer (ESBC) patients undergoing anthracycline-based chemotherapy are at moderate risk of developing febrile neutropenia (13.8%).…”