Now Available: Our 2023 State of Patient Empowerment Report Learn more >>

NCCN Breast Cancer Guidelines Update for 2022: what patients need to know

Written By:

breast cancer guidelines update
Doctor holding blood sample with DNA, molecule imagery


The National Comprehensive Cancer Network (NCCN)® is a not-for-profit alliance of 31 leading cancer centers devoted to patient care, research and education. At the beginning of every year, the NCCN releases updated treatment guidelines in breast cancer based on new FDA approvals and the latest scientific research. The 2022 Breast Cancer Clinical Practice Guidelines® for physicians include new treatment recommendations in early and late stage breast cancer. Outcomes4Me has updated its breast cancer app in order to make all these guideline changes easily accessible to patients as well as highlighting the major changes here.

Preoperative systemic therapy is now an option for all HER2+ and HR-/HER2- (TNBC) patients

Patients may receive systemic therapy, such as chemotherapy, before undergoing surgery to help reduce the size of the tumor and prevent recurrence. Previously, preoperative therapy was only recommended to patients who were considered to be at a high-risk of recurrence. However, in the recent update, the NCCN says that any HER2+ or TNBC patient may receive preoperative therapy. Note that preoperative therapy for HER2+ or TNBC patients who are considered to have a low risk of recurrence is optional, not required, so it is important to talk with your doctor about what treatment plan is right for you.

Abemaciclib (Verzenio®) as an option for high-risk early stage HR+/HER2- patients

The FDA recently approved abemaciclib in combination with endocrine therapy as a treatment option for HR+/HER2- early stage, high-risk breast cancer patients. In this case, high-risk means patients with ≥4 positive lymph nodes, or 1–3 positive lymph nodes with one or more of the following: Grade 3 disease, tumor size ≥5 cm, or a Ki-67 score of ≥20%. The approval was based on data from the monarchE study which showed a statistically significant improvement in time till recurrence in patients who received abemaciclib with endocrine therapy compared to endocrine therapy alone. Based on this data and FDA approval, the NCCN now states that abemaciclib can be considered for early stage, high-risk HR+/HER2- patients. Taking abemaciclib along with endocrine therapy is optional, not required for all patients who meet criteria.

Capecitabine (Xeloda) following radiation as treatment option for TNBC patients who did not receive treatment prior to surgery

The NCCN now states that capecitabine can be prescribed as a maintenance therapy following adjuvant chemotherapy for TNBC patients who did not receive preoperative therapy. Previously, the NCCN did not recommend capeciatibe to patients who had not received preoperative therapy. The NCCN also now states that capecitabine should be administered following radiation therapy, not given concurrently, in all cases where capecitabine is recommended. Capecitabine is an optional treatment and may not be prescribed to all patients who meet criteria so it is important to talk to your doctor about capecitabine in the context of your personal treatment plan.

Fam-trastuzumab deruxtecan-nxki (Enhertu®) added as preferred second-line treatment option for HER2+ metastatic breast cancer (mBC)

The NCCN now recommends fam-trastuzumab deruxtecan-nxki:

  • As first-line treatment for HER2+ patients with rapid progression within 6 months of neoadjuvant or adjuvant therapy
  • As the preferred second-line therapy for HER2+ mBC patients.
  • As a third-line treatment option in HER2+ mBC.

This update is based on the promising data from the Phase III DESTINY-Breast03 study. The study showed that patients taking fam-trastuzumab deruxtecan-nxki demonstrated a 72% reduction in the risk of disease progression or death compared to trastuzumab emtansine (Kadcyla®), another treatment recommended in the second-line setting for HER2+ mBC.

Know your HR and HER2 status?

To learn more about your latest treatment options as it relates to the latest NCCN Guidelines® download the Outcomes4Me app today. You can also access your medical records and Outcomes4Me can provide you with a free, easy-to-read, customized summary report of your records. You’ll know what research is relevant to your breast cancer diagnosis instantly. Our clinical team will review your data to make sure your treatment plan matches the latest NCCN guidance. Outcomes4Me can also match eligible breast cancer patients with clinical trials when they are the best treatment option.


Center for Drug Evaluation and Research. “FDA Approves Abemaciclib with Endocrine Therapy for Early Breast Cancer.” U.S. Food and Drug Administration, FDA, 13 Oct. 2021, https://www.fda.gov/drugs/resources-information-approved-drugs/fda-approves-abemaciclib-endocrine-therapy-early-breast-cancer.

Cortes J, Kim S, Chung W, et al. Trastuzumab deruxtecan (T-DXd) vs Trastuzumab emtansine (T-DM1) in patients (Pts) with HER2+ metastatic breast cancer (mBC): Results of the randomized phase III DESTINY-Breast03 study. Presented at: European Society for Medical Oncology (ESMO) Congress 2021; September 16-21, 2021. Abstract LBA1.

Related Articles

A breast cancer diagnosis can be an overwhelming experience filled with complex terminology and metrics...
Navigating a breast cancer diagnosis involves confronting a myriad of uncertainties, not least of which...