| At the sixth annual meeting of the National Comprehensive Cancer Network (NCCN),
physicians outlined updates to the organization’s breast cancer treatment guidelines.
The updates include de-emphasizing high-dose chemotherapy/bone
marrow transplants for advanced breast cancer
patients, using breast MRI to help detect breast cancer in
certain cases, and checking for the overexpression of the HER2
gene on all breast cancer tumors to better determine treatment options. The NCCN is a
prestigious organization of 18 top cancer institutions; the NCCN’s breast cancer
treatment guidelines are updated each year and have become the treatment standard for
oncology professionals across the United States.
At the NCCN meeting, Richard Theriault, DO, of the University of Texas M.D. Anderson Cancer Center, said that NCCN has chosen to eliminate any mentioning of high-dose chemotherapy followed by bone marrow transplants for patients with metastatic (advanced) breast cancer. While the NCCN never recommended the treatment in previous versions of its guidelines, it did encourage patient participation in clinical trials. Dr. Theriault emphasized that high-dose chemotherapy is not associated with worse survival rates compared to other treatments. However, the high cost of the therapy (typically over $100,000) and its toxic nature does not warrant emphasizing it over other experimental treatments in the NCCN breast cancer treatment guidelines, especially since studies have shown no greater benefit than other therapies in clinical study. Clinical studies with high-dose chemotherapy should still be conducted and may benefit certain patients, said Robert Carlson, MD, of Stanford Medical Center.
The NCCN committee also mentioned that magnetic resonance imaging (MRI) of the breast may be helpful as a supplement to mammography in detecting or staging breast cancer in certain patients. MRI can be highly sensitive to small breast abnormalities and can often be used effectively on women with dense breasts. MRI can also play a significant role in the visualization of cosmetic breast implants. At the NCCN meeting, Dr. Carlson emphasized that MRI can be a favorable option for helping to detect breast cancer in some women only if the MRI technology is developed specifically for the breast and the exam is performed by a skilled breast imaging expert. In another update to the NCCN breast cancer treatment guidelines, the physicians recommended that HER2 (also spelled HER2/neu) gene testing be conducted on all breast cancer tumors in the same manner that physicians determine whether a tumor has estrogen or progesterone receptors (the presence of these receptors also helps determine a patient’s treatment). HER2 (human epidermal growth factor receptor 2) is a protein receptor found on the surface of cells and is a key component in regulating cell growth. Approximately 25% to 30% of breast cancer patients have extra copies of the HER2, which can signal aggressive-type cancers. However, a drug called Herceptin (generic name, trastuzumab) has shown to be effective in treating patients with this HER2 overexpression.
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