Report in English with a Dutch summary (KCE reports 63A)

More documents

Recommendations

Info

142 Breast Cancer KCE reports 63 95 Based on the criteria from the HERA trial (T > 1cm and/or previously chemotherapy), a 1 year treatment with adjuvant trastuzumab is indicated for women with HER2 FISH positive breast cancer, a LVEF of ≥ 55% and without cardiovascular exclusion criteria (1A evidence). 5 5 5 1 5 4 5 NA 4 3 5 96 During treatment with trastuzumab, cardiac function should be monitored (1A evidence). 5 5 5 5 5 4 5 NA 5 4 5 97 In premenopausal patients with HR+ or HR unknown metastatic breast cancer, suppression of ovarian function (e.g. with GnRH analogs, oophorectomy, irradiation of the ovaries) in combination with tamoxifen is the first-line hormonal therapy (1A evidence). 5 5 5 4 5 5 5 NA 5 5 4 98 In postmenopausal patients with HR+ or HR unknown metastatic breast cancer, first-line treatment consists of aromatase inhibitors. Tamoxifen remains an acceptable alternative as first-line treatment. As second-line treatment, anastrozole, letrozole or exemestane are recommended (1A evidence). 5 5 5 1 5 5 5 NA NA 3 4 99 Chemotherapy for patients with metastatic breast cancer is indicated for the following conditions (1A evidence): a. hormone refractory or HR- tumours b. rapidly progressive disease c. invasion of life-threatening organs 5 5 5 5 5 4 5 NA 5 5 5 100 The preferred chemotherapy regimen is to be discussed in the MDT (expert opinion). 101 Trastuzumab should be reserved for those patients whose tumours have HER2 overexpression (1A evidence). 5 5 5 2 5 5 5 NA 5 4 5 5 5 5 2 5 5 NA NA 5 5 5 102 Combination therapy of trastuzumab with a taxane is recommended in women with metastatic breast cancer (1A evidence). 5 5 5 2 5 5 NA NA NA 4 4 4,20 5 1,32 80% 4,80 5 0,42 100% 4,80 5 0,42 100% 4,22 5 1,39 78% 4,90 5 0,32 100% 4,60 5 0,97 90% 4,67 5 1,00 89% 4,38 5 1,06 88% 4. in HERA (and in the US studies) HER-2 positivity by IHC 3+ was also considered positive and other studies have shown it to be highly correlated with response to Herceptin; additionally, very recent results from the NCCTG study show that IHC 3+ may even respond better to Herceptin than FISH+ IHC 2+; our reimbursement law should include both FISH+ or IHC 3+ 10. 1 year? Or concomitant with taxanes? 4. should be added "when chemotherapy is not indicated" 4. There is enough data to support the use of Fulvestrant after an AI and as a very valuable option for metastatic breast cancer 10. AI not mandatory 4. It must be discussed and decided in a group meeting of medical oncologists not in a multidisciplinary team meeting 4. the correct wording would be "whose tumours have HER2 overexpression or amplification (1A evidence)." 9. and Fish control 10. gene amplification rather than overexpression 4. is recommended in women with HER-2 positive metastatic breast cancer (1A evidence).
KCE reports 63 Breast Cancer 143 103 Bisphosphonates should be routinely used in combination with other systemic therapy in patients with metastatic breast cancer with bone metastases (1A evidence). 5 5 5 4 5 5 5 NA 5 1 5 104 In patients with painful bone metastases, radiotherapy is a viable treatment option (1A evidence). 5 5 5 5 5 5 5 NA 5 3 5 105 A local recurrence in the thoracic wall should be treated preferentially with surgery and adjuvant radiotherapy (1C evidence). 106 A recurrence after breast-conserving surgery should be treated by a salvage mastectomy (1C evidence). 107 Systemic treatment for a locoregional recurrence should be discussed in the MDT (expert opinion). 4 5 4 2 5 4 5 NA 2 5 5 4 5 5 5 5 5 5 NA 4 5 5 5 5 5 2 5 5 5 NA 5 5 5 108 Treatment with bisphosphonates is not recommended in women with breast cancer without clinically evident bone metastases (1A evidence). 5 2 5 5 5 5 5 NA 5 5 5 109 Physiotherapy after axillary surgery is recommended (2A evidence). 4 4 3 5 5 5 1 NA 5 4 3 110 Physical training after treatment for breast cancer is recommended (2A evidence). 4 4 5 4 5 4 5 NA 5 4 4 111 Menopausal HRT is contraindicated in women with breast cancer (1C evidence). 4 5 5 5 5 5 5 NA 5 5 3 112 Psychological support should be available to all patients diagnosed with breast cancer (1A evidence). 5 5 5 5 5 5 5 NA 5 5 5 113 The possibility of breast reconstruction should be discussed with all patients prior to mastectomy (1C evidence). 4 5 5 5 5 5 5 NA 5 5 5 114 Yearly mammo/ultrasonography should be used to detect recurrence or second primaries in patients who have undergone previous treatment for breast cancer (1C evidence). 4 5 5 5 5 5 1 5 5 5 5 4,50 5 1,27 90% 4,80 5 0,63 90% 4,10 4,5 1,20 80% 4,80 5 0,42 100% 4,70 5 0,95 90% 4,70 5 0,95 90% 3,90 4 1,29 70% 4,40 4 0,52 100% 4,70 5 0,67 90% 5,00 5 0,00 100% 4,90 5 0,32 100% 4,55 5 1,21 91% 10. only if multiple and lytic 10. if localized; with systemic trt 3. if the chest wall was not irradiated before 4. and adjuvant radiotherapy (1C evidence) if not given before - like it is it seems re-irradiation should always be considered and that is not the case 9. Not clear to me , complete evaluation is necessary to confirme the recur is isolated 1. breast conserving surgery may be an option 4. since the answer to this question is unknown it should also say "and patients should be offered to participate in clinical trials" 2. except in osteoporotic patients 3. Not with the case of SNB. Reeducation on the first postoperative day is usually sufficient 7. NO PROOF AVAILABLE 1. every 6 moths for the treated breast during the first 2-3 years 7. TWICE YEARLY ?
Page 1 and 2:
Wetenschappelijke ondersteuning van
Page 3 and 4:
Wetenschappelijke ondersteuning van
Page 5:
Elke gedeeltelijke reproductie van
Page 8 and 9:
ii Nationale praktijkrichtlijn voor
Page 10 and 11:
iv Nationale praktijkrichtlijn voor
Page 12 and 13:
vi Nationale praktijkrichtlijn voor
Page 15 and 16:
KCE reports 63 Breast Cancer 1 ABBR
Page 17 and 18:
KCE reports 63 Breast Cancer 3 Tabl
Page 19 and 20:
KCE reports 63 Breast Cancer 5 1 IN
Page 21 and 22:
KCE reports 63 Breast Cancer 7 5. W
Page 23 and 24:
KCE reports 63 Breast Cancer 9 2.3.
Page 25 and 26:
KCE reports 63 Breast Cancer 11 3 F
Page 27 and 28:
KCE reports 63 Breast Cancer 13 3.3
Page 29 and 30:
Page 31 and 32:
Page 33 and 34:
Page 35 and 36:
KCE reports 63 Breast Cancer 21 met
Page 37 and 38:
Page 39 and 40:
KCE reports 63 Breast Cancer 25 rad
Page 41 and 42:
KCE reports 63 Breast Cancer 27 bas
Page 43 and 44:
KCE reports 63 Breast Cancer 29 Bes
Page 45 and 46:
Page 47 and 48:
KCE reports 63 Breast Cancer 33 111
Page 49 and 50:
KCE reports 63 Breast Cancer 35 5 R
Page 51 and 52:
KCE reports 63 Breast Cancer 37 41.
Page 53 and 54:
KCE reports 63 Breast Cancer 39 81.
Page 55 and 56:
Page 57 and 58:
Page 59 and 60:
Page 61 and 62:
Page 63 and 64:
Page 65 and 66:
KCE reports 63 Breast Cancer 51 APP
Page 67 and 68:
KCE reports 63 Breast Cancer 53 Sou
Page 69 and 70:
KCE reports 63 Breast Cancer 55 Stu
Page 71 and 72:
Page 73 and 74:
KCE reports 63 Breast Cancer 59 Dia
Page 75 and 76:
KCE reports 63 Breast Cancer 61 Dia
Page 77 and 78:
Page 79 and 80:
Page 81 and 82:
Page 83 and 84:
KCE reports 63 Breast Cancer 69 Rad
Page 85 and 86:
KCE reports 63 Breast Cancer 71 Tre
Page 87 and 88:
Page 89 and 90:
Page 91 and 92:
Page 93 and 94:
Page 95 and 96:
Page 97 and 98:
Page 99 and 100:
Page 101 and 102:
Page 103 and 104:
Page 105 and 106: KCE reports 63 Breast Cancer 91 Stu
Page 115 and 116: KCE reports 63 Breast Cancer 101 St
Page 127 and 128: KCE reports 63 Breast Cancer 113 Tr
Page 129 and 130: KCE reports 63 Breast Cancer 115 Tr
Page 131 and 132: KCE reports 63 Breast Cancer 117 Ph
Page 135 and 136: KCE reports 63 Breast Cancer 121 Ps
Page 141 and 142: KCE reports 63 Breast Cancer 127 Re
Page 145 and 146: KCE reports 63 Breast Cancer 131 N
Page 147 and 148: KCE reports 63 Breast Cancer 133 17
Page 155: KCE reports 63 Breast Cancer 141 85
Page 159 and 160: 5 10 15 20 25 30 35 KCE reports 63
Page 161 and 162: 5 10 15 20 25 KCE reports 63 Breast
Page 163 and 164: This page is left intentionally bla
Page 165 and 166: KCE reports 1. Effectiviteit en kos
show all

Report in English with a Dutch summary (KCE reports 63A)

Create successful ePaper yourself

Delete template?

Save as template?