Welcome to the July issue of the Clinical Research Connection. We value the partnership we have with our affiliate network and hope this newsletter will provide an opportunity for enhanced communication and interaction, and advance our collective strength in the area of oncology research.
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The National Comprehensive Cancer Network (NCCN) recently updated the NCCN Clinical Practice Guidelines in Oncology™ for Breast Cancer Screening and Diagnosis and continues to recommend annual clinical breast examinations and mammography for women 40 years and older at normal risk. The Robert H. Lurie Comprehensive Cancer Center of Northwestern University, a founding member of the NCCN, supports these recommendations.
The U.S. Preventive Services Task Force's most recent recommendation that mammography screenings start at age 50 "work against women's health. They are putting women in jeopardy," says Ellen Mendelson, MD, Director of Breast and Women's Imaging at Northwestern's Lynn Sage Comprehensive Breast Center. "Given the decreased mortality of breast cancer patients under the age of 50, we have
not altered our belief that annual mammograms for women age 40 and over are beneficial," concurs Virginia Kaklamani, MD, DSc, medical oncologist at the Lurie Cancer Center.
Annual clinical breast examinations and screening mammography, with breast awareness encouraged is stated in the NCCN Guidelines as a recommendation for women 40 years and older at normal risk. Although the interval of screening in women aged 40 to 49 remains controversial, the NCCN Guidelines clearly recommend annual screenings since mammograms can often detect a lesion two years before the lesion is discovered by a clinical breast examination.
"Age should not be the sole determining factor at either end of the spectrum when we consider who should have regular mammograms," says William Gradishar, MD, Director of Breast Medical Oncology at the Lurie Cancer Center. "If I see someone who's vibrant and vigorous in their 70s, I'm going to lean in favor of screening. "
Therese B. Bevers, MD, University of Texas M.D. Anderson Cancer Center and chair of the NCCN Guidelines Panel for Breast Cancer Screening and Diagnosis, notes "It is imperative to consider the patient's individual risk factors when considering an appropriate screening routine." Dr. Bevers adds that adhering to a risk-based assessment method reinforces the concept that physicians should discuss the benefits and risks of screening with their patients.
The intent of the NCCN Guidelines for Breast Cancer Screening and Diagnosis is to provide health care providers with a practical, consistent framework for screening and evaluating a spectrum of breast lesions. However, the NCCN Guidelines Panel emphasizes that clinical judgment should always be an important component of the optimal management of a patient.
NCCN guidelines are the recognized standard for clinical policy in the oncology community, with recommendations based on the best evidence and consensus of clinical experts. Recommendations are updated and revised continuously to reflect new data and new clinical information to assist oncologists in making major clinical decisions in managing patients.
Recently updated guidelines for bone cancer, colon cancer, multiple myeloma, prostate and rectal cancer have been issued and are now available.
For more information, visit recent updates to NCCN Clinical Practice Guidelines in Onocology.
- Bone Cancer: specific recommendations for common systemic therapy agents/regimes are included in the new page entitled, 'Bone Cancer Systemic Therapy Agents', Version 2.2010.
- Colon/Rectal Cancers: For patients with advanced or metastatic disease, an alternative option, panitumumab was added to combining therapies with FOLFOX and FOLFIRE. Panitumumab has been added as a second-line treatment option for patients that are progressing on FOLFOX +/- bevacizumab, changing the category 2B recommendation to category 2A for FOLFIRI+cetuximab in second-line therapy. Cetuximab was removed from combination therapies capecitabine and oxaliplatin.
- Multiple Myeloma: Updated chapters are for Lenalidomide as Maintenance therapy and NCCN Drugs & Biologics Compendium (NCCN Compendium) in version 3.2010. A footnote for Lenalidomide as an option for maintenance therapy has been added. An evaluation of Lenalidomide in three independent randomized clinical trials resulted in improvements in TTP. The recommendation remains as Category 2A due to requirement for a full peer review and safety/efficacy data.
- Prostate: Updated chapters are for NCCN Drugs & Biologics Compendium (NCCN Compendium) chapter in Version 1.2010.
About the National Comprehensive Cancer Network
The National Comprehensive Cancer Network (NCCN), a not-for-profit alliance of 21 of the world's leading cancer centers, is dedicated to improving the quality and effectiveness of care provided to patients with cancer. Through the leadership and expertise of clinical professionals at NCCN Member Institutions, NCCN develops resources that present valuable information to the numerous stakeholders in the health care delivery system. As the arbiter of high-quality cancer care, NCCN promotes the importance of continuous quality improvement and recognizes the significance of creating clinical practice guidelines appropriate for use by patients, clinicians, and other health care decision-makers. The primary goal of all NCCN initiatives is to improve the quality, effectiveness, and efficiency of oncology practice so patients can live better lives. For more information, visit NCCN.org.