National Comprehensive Cancer Network

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NCCN Guidelines and Compendium Updated

NCCN Flash Updates™ sent January 17, 2013

NCCN has published updates to the NCCN Chemotherapy Order Templates (NCCN Templates^®) for the following disease sites:

• Anal Carcinoma
• Kidney Cancer

NCCN has published updates to the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines^®) for Non-Small Cell Lung Cancer. These NCCN Guidelines^® are currently available as Version 2.2013.

• The Discussion section has been updated to represent the changes in the algorithm.

*For your reference, the announcement of the previous update (Version 1.2013) to the NCCN Guidelines for Non-Small Cell Lung Cancer, distributed on December 5, 2012, is included below:

NCCN has published updates to the NCCN Guidelines^® for Non-Small Cell Lung Cancer. These NCCN Guidelines are currently available as Version 1.2013.

• A new section was added addressing the diagnostic evaluation of lung nodules suspicious for cancer.
• A new section was added addressing the management of multiple lung cancers.
• Metastatic disease: workup and evaluation of histologic subtype
  • The clarification "with adequate tissue for molecular testing" was added to "Establish histologic subtype"
  • "Smoking cessation counseling" was added.
  • For squamous cell carcinoma: the clarification "except in never smokers and small biopsy specimens" was added to "EGFR mutation and ALK testing are not routinely recommended"
• Metastatic disease: adenocarcinoma, large cell, or NSCLC not otherwise specified (NOS) that is negative for EGFR mutations or ALK gene fusions
• "If ROS1 mutation status is known and positive, may treat with crizotinib" was added as a footnote to ALK testing.
• Continuation maintenance therapy
  • Pemetrexed changed to a "category 1" recommendation from a "category 2A" recommendation.
  • Bevacizumab + pemetrexed added with category 2A recommendation and the following footnote "kk": "If bevacizumab was used with a first-line pemetrexed/platinum chemotherapy regimen."
• Metastatic disease: adenocarcinoma, large cell, or NSCLC NOS that is positive for EGFR mutations or ALK gene fusions
  • EGFR mutation discovered during first-line chemotherapy: "May add erlotinib to current chemotherapy" changed to a "category 2A" recommendation from a "category 2B" recommendation.
  • Therapy added for progression on erlotinib
• Chemotherapy Regimens Used With Radiation Therapy
  • Two new concurrent chemotherapy/RT regimens were added:
    • "Carboplatin AUC 5 on day 1, pemetrexed 500 mg/m2 on day 1 every 21 days for 4 cycles; concurrent thoracic RT (nonsquamous)"
    • "Cisplatin 75 mg/m2 on day 1, pemetrexed 500 mg/m2 on day 1 every 21 days for 3 cycles; concurrent thoracic RT (nonsquamous)"
• Principles of Pathologic Review, Principles of Radiation Therapy, and Principles of Surgical Therapy were updated.
• Chemotherapy Regimens for Neoadjuvant and Adjuvant Chemotherapy
  • For the cisplatin/gemcitabine and cisplatin/docetaxel regimens, clarified number of cycles as "4 cycles."
• Systemic Therapy for Advanced or Metastatic Disease
  • A new treatment option was added: "albumin-bound paclitaxel in combination with carboplatin with a category 2A recommendation."

For the complete updated versions of the NCCN Guidelines^® and the NCCN Compendium^®, please visit NCCN.org.

To view the NCCN Guidelines for Patients^®, please visit NCCN.com.

To access free NCCN Guidelines mobile apps for iPhone and Android, visit NCCN.org/mobile.

Now Available! The Virtual Library of NCCN Guidelines are now formatted for iPad and Android. Visit NCCN.org/mobile/tablet.asp.