NCCN Flash Update: Changes to NCCN Guidelines for Breast Cancer Version 4.2025

The National Comprehensive Cancer Network (NCCN) has released updates to the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Breast Cancer, Version 4.2025 on April 30, 2025, reflecting the latest evidence and evolving standards in breast cancer care. These revisions have significant implications for oncology pharmacy professionals, particularly in areas such as regimen selection, sequencing, febrile neutropenia risk, and supportive care.

Key updates involve treatment indications for agents such as olaparib (Lynparza; AstraZeneca) and capecitabine, as well as combination regimens that include carboplatin, paclitaxel, cyclophosphamide, anthracyclines (doxorubicin or epirubicin), and pembrolizumab (Keytruda; Merck & Co) for both neoadjuvant and adjuvant settings. These modifications reflect the growing integration of immunotherapy in early-stage triple-negative breast cancer, emphasizing the need for precise regimen sequencing and patient selection.

Additionally, the risk classification for febrile neutropenia has been revised for select multi-agent regimens involving immunotherapy, highlighting the importance of appropriate prophylaxis and monitoring strategies. Oncology pharmacists would benefit from being prepared to assess these risks within the context of patient-specific factors and institutional protocols.

There is also a reaffirmation of clinical flexibility in the administration sequence of anthracycline- and taxane-based regimens. Notably, it is now explicitly acceptable to administer taxane-containing components prior to anthracycline-based therapy in certain settings. This sequencing option is supported by data suggesting comparable efficacy and may allow for better tolerability or improved logistical planning.

Updates have also been made to drug-specific information for several commonly used agents, including ado-trastuzumab emtansine (Kadcyla; Genentech) carboplatin, docetaxel, leuprolide acetate, paclitaxel, pembrolizumab, pertuzumab (Perjeta; Genentech), and trastuzumab (Herceptin; Roche), including its subcutaneous formulations. These changes span guidance on supportive care, safety monitoring, dose holds, and special administration instructions, reinforcing the pharmacist’s role in ensuring treatment safety and optimization.

Pharmacy professionals are encouraged to review these guideline updates in full to align clinical practice with the latest updates. Staying informed of such changes is essential to maintaining best practices in breast cancer pharmacotherapy and supporting high-quality patient care.

REFERENCE

NCCN Flash Updates: NCCN Guidelines Updated for Colon Cancer. Email. National Comprehensive Cancer Network. April 30, 2025. Accessed April 30, 2025.