NCCN guidelines for surveillance of metastatic breast cancer 2015v3

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Monitoring Metastatic DiseaseMonitoring of metastatic diseaseMonitoring the treatment of metastatic breast cancer involves a wide array of a


Monitoring Metastatic Disease

Monitoring of metastatic disease

Monitoring the treatment of metastatic breast cancer involves a wide array of assessments and the need for the clinician to integrate several different forms of information to make a determination of the effectiveness of treatment and the acceptability of toxicity.

Therapeutic monitoring of metastatic breast cancer includes extensive evaluation and the need for clinicians to integrate different forms of information to determine the efficacy and toxicity of treatment.

The information includes those from direct observations of the patient including patient, reported symptoms, performance status, change in weight, and physical examination laboratory tests such as alkaline; phosphatase, liver function, blood counts, and calcium; radiographic imaging; functional imaging; and, where appropriate, tumor biomarkers.

This information includes the direct observation of the patient, including the patient's symptoms, behavior and body weight changes and physical examination; laboratory tests such as alkaline phosphatase, liver function, blood cell count and calcium; radiography; functional imaging; and, where appropriate, tumor biomarkers.

The results these evaluations are classified as response, continued response treatment to, stable disease, uncertainty regarding disease status, or progression of disease. generally

The results of these assessments are generally divided into response, response to treatment, disease stabilization, uncertainty, or progression.

The clinician typically must assess and balance multiple different forms of information to make a determination regarding whether disease is being controlled and the toxicity of treatment is acceptable.

Clinicians often have to evaluate and balance many different types of information to determine whether the disease is under control and whether the treatment is acceptable.

Sometimes this may be information contradictory.

Sometimes, information may contradict each other.

The panel recommends widely criteria for reporting response, stability, and progression disease as the RECIST criteria and the WHO using criteria. such of accepted

The panel recommends the use of recognized standards such as the RECIST standard and the WHO standard to report disease response, stability, and progress.

The NCCN Panel recommends the same of assessment method over also using time.

The NCCN team also recommends using the same assessment method in the future.

For example, an abnormality found diagnostic CT of chest should be with repeat diagnostic CT scans monitored of the chest. initially the scan on

For example, an initial diagnosis of chest CT scan revealed an abnormality that should be repeated with a diagnostic chest CT scan.

The optimal frequency testing is uncertain, and is based the monitoring strategies in breast cancer primarily clinical trials. utilized on of

The optimal frequency of diagnosis is not clear, so it is based primarily on monitoring strategies used in breast cancer clinical trials.

The page titled Principles of Monitoring Metastatic Disease in the algorithm provides a table outlining general recommendations for the frequency and type of monitoring as a baseline before initiation of new therapy, for monitoring the effectiveness of cytotoxic chemotherapy and endocrine therapy, and as an assessment when there is evidence of disease progression.

The page title for the monitoring principle of metastatic disease, the procedure provides a baseline monitoring table, type and frequency of the start is generally recommended in the new treatment, for monitoring the effectiveness of cytotoxic chemotherapy and endocrine therapy, and assessment of disease progression as evidence.

The panel has in footnote that frequency of can be reduced in patients who have long-term the stable disease. monitoring a indicated

In a footnote, the panel noted that patients with chronic disease can reduce the frequency of monitoring.

These are guidelines should be for individual using clinical judgment, especially for with stable responding disease for long those periods of time. or the patient and modified

These are guidelines for specific patients, especially those with stable disease or long-term responders who should be adjusted for clinical judgment.

The clinical use Circulating Tumor Cells (CTC) in breast is not included in algorithms for disease assessment and cancer monitoring. yet metastatic of

The clinical application of circulating tumor cells (CTC) in metastatic breast cancer has not yet been included in the work of disease assessment and monitoring.

Patients with persistently CTC after 3 weeks first-line have a poor PFS and OS. chemotherapy increased of

Patients who continued to increase CTC after 3 weeks of first-line chemotherapy had adverse PFS and OS.

In spite of prognostic ability, CTC count failed to a show predictive value. has its

Although the CTC count has prognostic power, it does not show predictive value.

A prospective, randomized, phase 3 trial (SWOG S0500) evaluated clinical utility serial of CTC in patients with metastatic enumeration breast cancer. the

A prospective, randomized, phase 3 trial (SWOG S0500) was performed to assess the clinical utility of a series of CTC counts in patients with metastatic breast cancer.

According to the results study, switching an cytotoxic therapy 3 weeks first-line chemotherapy in with persistently increased CTC did not patients affect either PFS alternative or OS. to after

According to the results, 3 consecutive patients with elevated CTC after first-line chemotherapy were not affected by PFS after conversion to an alternative cytotoxic treatment without affecting OS.

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