|
The National Comprehensive Cancer Network (NCCN), an organization of 19 leading cancer care centers in
the United States, updated its Breast Cancer Clinical Practice Guidelines in December 2005 to
reflect recent advances in breast cancer treatment. The guidelines are meant to provide
direction for healthcare professionals who treat women with breast cancer. The updated
guidelines cover several new areas in breast cancer research. For example, the
NCCN now recommends that clinicians take into account hormone receptor status (i.e.,
whether a patient's cancer is dependent upon estrogen) when determining breast cancer
treatment options. The guidelines also provide guidance to clinicians on the use of
new breast cancer drug therapies.
According to the NCCN, its Clinical Practice Guidelines in Oncology are "developed and updated through a
consensus-driven process with explicit review of the scientific evidence by multidisciplinary panels of
expert physicians from NCCN institutions." Click here for a list of
NCCN institutions.
The updated version of the NCCN treatment guidelines now place a greater emphasis on adjuvant, or
additional, therapies, such as chemotherapy or
radiation, in conjunction with surgery, for
patients with early-stage breast cancer. In particular, the NCCN recommends that clinicians
consider factors such as whether breast cancer has spread to the nearby lymph nodes or
whether it is "estrogen-receptor positive" or "estrogen-receptor negative." Estrogen-receptor positive
cancers depend on the hormone estrogen for survival. It is important to weigh hormone
status when considering breast cancer treatment because patients with estrogen-receptor positive
breast cancer may be candidates for hormonal therapies, such as
the drug tamoxifen.
Another factor the NCCN guidelines recommend that clinicians consider when weighing treatment options
is HER2 status. HER2 (human epidermal growth factor
receptor 2) is a protein found on the surface of cells that, when functioning normally, has been
found to be a key component in regulating cell growth. However, when the HER2 protein is
altered, extra HER2 protein receptors may be produced. This over-expression of HER2 causes increased
cell growth and reproduction, often resulting in more aggressive breast cancer cells. HER2 protein
over-expression affects approximately 20% to 30% of breast cancer patients. Women with HER2
over-expression may not be as responsive to standard breast cancer treatments, including certain regimens of chemotherapy.
Promising research shows that patients whose breast cancer tumors over-express the HER2 gene may benefit from the
drug, Herceptin (generic name, trastuzumab). For
example, the results of two clinical trials announced by the U.S. National Institutes of
Health in 2005 showed that Herceptin, combined with chemotherapy, can significantly reduce the
chances of a breast cancer recurrence in women with HER2 positive breast cancer.
In terms of treating advanced breast cancer, the NCCN has expanded its guidelines of appropriate
options. Based on recent research, drugs including paclitaxel (brand name, Taxol) plus
bevacizumab (Avastin) and albumin-bound paclitaxel (Abraxane) have been added to the NCCN's recommendations.
In addition to the newly updated clinician guidelines, the NCCN also updated its patient version of
its Breast Cancer Treatment Guidelines in August 2005, in collaboration with the American Cancer Society. The
patient guidelines translate the NCCN's guidelines into easy-to-understand language and include tools such
as "decision trees" to aid patients in search of information about breast cancer treatment options.
Additional Resources and References
- The NCCN Breast Cancer Clinical Practice Guidelines (updated December 2005) are available on the
NCCN website at http://www.nccn.org/.
- This article references the December 6, 2005 NCCN news release, "NCCN Announces Two New Breast
Cancer Resources," which was published on the NCCN website.
- To learn more about the NCCN patient guidelines, please visit
http://www.imaginis.com/breasthealth/treatmentguidlines.asp
|
