NCCN Updates Guidelines on Breast Cancer Treatment

TON - Daily
Despite the US Food and Drug Administration's (FDA) misgivings about the use of bevacizumab (Avastin) in patients with advanced breast cancer, the National Comprehensive Cancer Network (NCCN) has announced that it will continue to include the combination of bevacizumab and paclitaxel in its treatment guidelines for metastatic breast cancer. At the NCCN annual meeting last week, Robert W. Carlson, MD, Stanford Comprehensive Cancer Center, California, chair of the panel responsible for reviewing the guidelines, said the data had not really changed since the FDA granted fast-track approval for the bevacizumab indication in 2008. "We thought that if the data were compelling 2 years ago, why isn't it compelling enough today?" Carlson said.
 
In consideration of the controversy, the panel did add a footnote to the guidelines on preferred treatment for metastatic breast cancer, which says
 
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.
 
Carlson said the panel had several "marathon sessions" to discuss the issue. They concluded that the original study upon which approval was based and more recent studies continued to show some improvement in disease control with the bevacizumab/paclitaxel combination. Carlson said they were not as confident in the use of bevacizumab with other approved chemotherapy agents.
 
Additional changes to the NCCN breast cancer guidelines include the addition of eribulin (Halaven) monotherapy for women with previously treated metastatic breast cancer, denosumab (Xgeva) to help prevent skeletal-related events. The panel declined to recommend routine testing for the CYP 2D6 gene after concluding that the data were conflicting.
 

The updated guidelines are available at the NCCN Website, www.nccn.org.

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