Breast cancer Adjuvant therapy for DCIS recommends tamoxifen According to Carlson, chair of the 2009 edition of the NCCN Practice Guidelines Breast Cancer Group, adjuvant therapy with tamoxifen is strongly recommended for 5 years for ductal carcinoma in situ (DCIS), including breast-conserving surgery + radiotherapy or breast-conserving surgery only, as well as for mastectomy patients. For stage I, IIA and IIB breast cancer patients, tamoxifen may be used to reduce the risk of contralateral breast cancer if not used as adjuvant therapy. Genetic counseling for those at genetic risk McCormick of the Sloan-Kettering Cancer Center noted that the new guidelines recommend genetic counseling for patients with ductal carcinoma in situ or early invasive breast cancer when genetic testing suggests a high risk of hereditary breast cancer. This recommendation is based on the results of a 2007 study. The study showed that for patients with unilateral breast cancer and a high genetic risk, the proportion of those undergoing bilateral mastectomy increased from 1998 to 2003 (from 4% to 11%) and is likely to be higher in the reanalysis. This new recommendation will help these patients to make better informed treatment choices. Whole-breast radiotherapy is not recommended for all patients with early-stage breast cancer The previous guidelines recommended that all early-stage breast cancer receive whole-breast radiotherapy; the new guidelines change this to an optional treatment. The revision is based on a large sample of EORTC studies that showed that radiotherapy did not have a significant effect on preventing recurrence at 8 years in patients over 60 years of age; radiotherapy had a significant effect in patients under 40 years of age and also in patients 41-50 and 51-60 years of age, but not as much as in younger patients, so the new guidelines make it optional. Local palliative treatment for metastatic breast cancer is beneficial A very important footnote in the new edition of the guidelines is that local surgery and/or radiation therapy may be beneficial for patients with metastatic breast cancer, and usually this palliative local treatment is only considered after initial systemic therapy has been effective. Data from the National Cancer Institute show that more patients are undergoing surgery as soon as metastatic breast cancer is diagnosed, rather than waiting for disease progression, and that median patient survival can be extended by a factor of 1 (to approximately 2 years) if the margins are clean, noted Edge, Roswell Park Cancer Institute. Adjuvant therapy has specific recommendations Edge noted that the NCCN guidelines now include recommendations for adjuvant therapy, and that adjuvant therapy is no longer “a matter of personal preference. For patients not receiving trastuzumab, the recommended regimens are: TAC regimen (docetaxel + doxorubicin + cyclophosphamide), dose-dense AC (doxorubicin + cyclophosphamide) + paclitaxel every 2 weeks, TC regimen (docetaxel + cyclophosphamide), and AC regimen. For patients treated with trastuzumab, the recommended adjuvant regimens are AC followed by docetaxel with trastuzumab, and TCH (docetaxel + carboplatin + trastuzumab). Non-small cell lung cancer For first-line treatment recommendations Professor Ettinger, chair of the NCCN Guidelines Steering Committee and leader of the NCCN Non-Small Cell Lung Cancer Guidelines Expert Panel, noted that for patients with a physical status (PS) score of 0 to 1 who meet the criteria (including having undergone mutation detection analysis), cetuximab + vincristine + cisplatin regimens and pemetrexed + cisplatin regimens can be considered as first-line treatment option. The former regimen can be used for patients with a PS score of 2. For patients with a PS score of 3-4, chemotherapy or targeted drug therapy is not recommended, but rather best supportive care. Recommendations for the use of erlotinib are based on genetic status Erlotinib in combination with or without chemotherapy is recommended for patients with epidermal growth factor receptor (EGFR) mutations or gene activation, or for non-smoking patients; treatment other than erlotinib should be considered if the patient has KRAS gene mutations in the tumor tissue. KRAS gene sequencing can help in patient selection for tyrosine kinase inhibitor therapy. Erlotinib is significantly better than best supportive care for third-line therapy in patients eligible for dosing. New recommendation for pemetrexed The guideline adds a recommendation for pemetrexed for the treatment of patients with non-squamous cancer types, but as a Class 2B recommendation, for which there was not full agreement among the panel members.