Updated NCCN Guidelines for Breast Cancer outline expanded treatment options

February 11, 2016

Continuing to capture public interest and attention, Dr. Carlson reviewed the research and evidence leading to the decision for the NCCN Guidelines Panel to reaffirm its existing recommendation of bevacizumab (Avastin?, Genentech/Roche) in combination with paclitaxel (Taxol?, Bristol-Myers Squibb Company) as an appropriate therapeutic option for metastatic breast cancer.

The findings in the first large, randomized study of bevacizumab in combination with paclitaxel chemotherapy demonstrated an improvement in disease control and response, but no survival advantage compared with chemotherapy alone and led to both FDA approval of the combination and the addition of the combination to the NCCN Guidelines. Subsequently, several additional studies have been reported that also demonstrate a small disease control advantage with bevacizumab in combination with chemotherapy, but no survival advantage. On the basis of these studies, the NCCN Guidelines Panel continues to include the combination of bevacizumab and paclitaxel as an option. The Panel is less supportive of other chemotherapy agents in combination with bevacizumab.

The Panel revised the related footnote, which now states, "Randomized clinical trials in metastatic breast cancer document that the addition of bevacizumab to some first or second line chemotherapy agents modestly improves time to progression and response rates but does not improve overall survival. The time to progression impact may vary among cytotoxic agents and appears greatest with bevacizumab in combination with weekly paclitaxel."

The NCCN Guidelines are developed and updated through an evidence-based process with explicit review of the scientific evidence integrated with expert judgment by multidisciplinary panels of expert physicians from NCCN Member Institutions. The most recent version of this and all the NCCN Guidelines are available free of charge at NCCN. The NCCN Guidelines for Patients??: Breast Cancer is available at NCCN.

SOURCE National Comprehensive Cancer Network