Understanding the Importance of NCCN Guidelines in Metastatic TNBC

CURE Speaking Out | <b>Starting the Dialogue for Metastatic Triple-Negative Breast Cancer</b>

As part of its Speaking Out video series, CURE spoke with Dr. Rebecca Moroose, from Orlando Health Cancer Institute, and Dr. Virginia G. Kaklamani, from UT Health San Antonio, about the National Comprehensive Cancer Network guidelines and what they mean for patients.

Kristie L. Kahl: Dr. Moroose, I’ll start with you. Can you briefly explain what NCCN (National Comprehensive Cancer Network) guidelines are and how they would affect a patient when it comes to their treatment decisions?

Dr. Rebecca Moroose: The National Comprehensive Cancer Network is actually a consortium of about 30 or more academic and cancer institutes that are constantly looking at new science, constantly looking at updating guidelines for doctors that they can share with their patients for the best type of treatment, depending on the patient's diagnosis.

Kristie L. Kahl: Dr. Kaklamani, in particular, what should patients know when it comes to the NCCN guidelines?

Dr. Virginia G. Kaklamani: Well, the NCCN guidelines, as Dr. morose mentioned, are guidelines that have been brought together by physicians, colleagues of ours, they tend to be very inclusive. I know a lot of payers use those guidelines to decide whether to reimburse for treatments. And so they're not necessarily meant to tell physicians, “This is exactly what you need to do. They’re meant to tell health physicians, “These are the options that you have.” So you can pick and decide what's best for your patient.

Kristie L. Kahl: Dr. Moroose, can you discuss the current or most recent NCCN guidelines for metastatic triple-negative breast cancer, in particular, the physician guidelines that we had mentioned?

Dr. Rebecca Moroose: This is a very exciting time for metastatic triple-negative breast cancer. So, in addition to systemic chemotherapy, which was always the foundation of treating metastatic triple-negative breast cancer, now we know we can look for certain subtypes. For example, if a person has inherited their cancer, because they have a germline BRCA1 and BRCA1 mutation, they've added specific PARP inhibitors for that situation. if patients have expression of a receptor that makes a cancer hide from the immune system. Now we've got checkpoint inhibitors and immunotherapy we can add. And then for the first time, an antibody drug combination, called an antibody drug conjugate, that actually targets a specific protein that's overexpressed on triple-negative breast cancer. And that is really one of the exciting breakthroughs for this part of metastatic breast cancer.

Kristie L. Kahl: Dr. Kaklamani, it sounds like we're making a lot of strides in this space, which is great. So, in particular, what does this mean for this patient population?

Dr. Virginia G. Kaklamani: Well, we've been able to show that we can improve patient survival by giving them these more targeted approaches to their therapy. So, chemotherapy, and we've been using it for over 30 years to treat triple-negative breast cancer, there are some good chemo therapeutic drugs, but not all breast cancers are the same. And to be able to find subtypes of breast cancers where we can get the help from the immune system by using immunotherapy is extremely important. And thankfully, those are shown so far to improve survival, those patients that express these specific markers.

Kristie L. Kahl: I think you made a great point there, you know, not all breast cancers are treated the same. So, from the physician perspective, how do these guidelines play a role in the conversations that you're having with your patients and that the patient should be having with their health care provider about their treatment options?

Dr. Virginia G. Kaklamani: Well, I always tell patients that they have to be their own best advocate. They need to be informed, obviously, they need to seek our help and guidance, but they need to know what's going on with their cancer, with their body. Because, at the end of the day, they're going to be the ones that decide what treatment they will be receiving, regardless of what we recommend.

Our job is to know the latest and the greatest, and to be able to apply that to the specific patient we have in front of us. But their job is to also have some understanding. And that's why these guidelines are so important. They don't just talk to physicians, they also talk to patients, so the patients can understand what we are doing and why we're doing it and make the right decision for themselves.

Dr. Rebecca Moroose: Absolutely agree with that. And I think patients need to understand their therapy options, the side effects from those options, and they should always ask if there is possibly a clinical research trial for which they could enroll and participate.