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DG DISPATCH - NCCN: Committee Stretches Recommendations For Tamoxifen By Edward Susman Special to DG News FT. LAUDERDALE, FL. -- March 17, 2000 -- The National Comprehensive Cancer Network's (NCCN) latest version of breast cancer treatment algorithms recommends an expanded use of tamoxifen to prevention recurrence to the contralateral breast. Dr. Robert Carlson, professor of medicine at Stanford University, Stanford, CA, and head of the NCCN's Breast Cancer Guidelines Committee, said, "Previous guidelines had recommended the use of tamoxifen to prevent recurrence of cancer in the original or ipsalateral breast," Carlson said. "We expanded that recommendation to the contralateral breast." Dr. Carlson spoke at the NCCN's annual meeting, being held in Ft. Lauderdale, FL on March 16-19, 2000. Dr. Carlson explained that new research reported by the National Surgical Adjuvant Breast and Bowel Project (NSABP) showed that tamoxifen treatment after lumpectomy surgery reduced by about 30 percent the risk of the cancer metastasis to the unaffected breast. He said studies also showed that the longer a women takes tamoxifen, the greater the reduction in this risk -- a 13 percent reduction after one year on tamoxifen; 26 percent after two year; 47 percent after five years. "These studies represent high level evidence of which we are very confident," Dr. Carlson said. He sounded a cautionary note, however, with regards to side effects of tamoxifen. Tamoxifen treatment can cause some serious side effects, he said, so the low risk of developing contralateral breast cancer has to be weighed against those side effects. "We are not at present at the point where we are saying that tamoxifen definitely should be used in this setting," he said. In another decision, the committee -- which has fine-tuned the treatment pathways five times in the five-year history of the NCCN guidelines -- deleted mentions of high-dose chemotherapy for treatment of metastatic breast cancer. Dr. Carlson said that in previous guidelines, the use of the controversial high-dose treatment was hinted at as a possible option for patients if performed in a properly designed clinical trial. Recent studies in the past year have indicated that there was no particular benefit from the high-dose procedure over conventional chemotherapy regimens. In other guidelines changes, Dr. Benjamin Anderson, associate professor of surgery at the University of Washington, in Seattle, WA, said the new recommendations suggest that doctors use neoadjuvant chemotherapy when trying to decide if a patient is a candidate for a lumpectomy or mastectomy. Dr. Anderson said NSABP trials indicated "we can improve breast conservation rates by giving chemotherapy upfront." He said that in some cases doctors face a dilemma in seeking to perform a lumpectomy. Dr. Anderson said that when the tumor size is borderline, pre-treatment with chemotherapy can shrink the tumor enough so that the lump can be removed safely. Related Link: Tamoxifen. E-mail this page to a friend or colleague! To print, use this version