In the guideline on advanced breast cancer NICE makes the following recommendations regarding treatment of the disease:
- Offer endocrine therapy as first-line treatment for the majority of patients with oestrogen receptor-positive disease.
- For those patients who are not suitable for anthracycline therapy offer systemic chemotherapy in the following sequence:
- first-line: single-agent docetaxel
- second-line: single-agent vinorelbine or capecitabine
- third-line: single-agent capecitabine or vinorelbine (whichever was not used second-line)
- For patients receiving treatment with trastuzumab, discontinue treatment with the drug at the time of progression outside the central nervous system.
The guideline also makes recommendations regarding diagnosis and assessment, supportive care and the management of complications.
The guideline on early and locally advanced breast cancer offers advice on some of the tests and treatments that patients should be offered, in particular:
- Reducing the amount of surgery under the arm
- Breast reconstruction when breast conservation is not possible
- Chemotherapy and endocrine treatments
- Biological treatments
With respect to drug therapy the guideline recommends that:
- Adjuvant chemotherapy or radiotherapy is started as soon as clinically possible within 31 days of completion of surgery in patients having these treatments
- Postmenopausal women with oestrogen receptor-positive early invasive breast cancer who are not considered to be at low risk are offered an aromatase inhibitor (anastrozole or letrozole), as their initial adjuvant therapy, or tamoxifen if an aromatase inhibitor is contraindicated or not tolerated.