National Comprehensive Cancer Network

About NCCN

NCCN Guidelines and Compendium Updated

Flash Update Sent August 30, 2012
NCCN has published updates to the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) and NCCN Drugs and Biologics Compendium (NCCN Compendium®) for Colon Cancer and the NCCN Guidelines® for Rectal Cancer. These NCCN Guidelines are currently available as Version 1.2013.

  • Colon Cancer
    • Surveillance for stage 0/I colon cancer changed to follow-up with colonoscopy only.
    • The listing of "preferred" removed from the combination regimen FOLFOX for adjuvant therapy for high risk stage II disease.
    • The following footnote was added to FOLFOX, FLOX, CapeOx for adjuvant therapy for high risk stage II disease: "A survival benefit has not been demonstrated for the addition of oxaliplatin to 5-FU/leucovorin in stage II colon cancer. Tournigand C, André T, Bonnetain F, et al. Adjuvant therapy with fluorouracil and oxaliplatin in stage II and elderly (between ages 70 – 75 years) with colon cancer: a subgroup analyses of the Multicenter International Study of oxaliplatin, fluorouracil, and leucovorin in the adjuvant treatment of colon cancer trial. J Clin Oncol 2012; published online ahead of print on August 20, 2012"
    • The following footnote added to FOLFOX, FLOX, CapeOx for high risk stage II disease and stage III disease: "A benefit for the addition of oxaliplatin to 5-FU/leucovorin in patients age 70 and older has not been proven."
    • The combination regimen of capecitabine + oxaliplatin changed to a preferred option in adjuvant therapy for T1-4, N1-2, M0.
    • Adjuvant therapy for resectable synchronous liver and/or lung metastases changed from recommendations on COL-4 to FOLFOX or CapeOx preferred.
  • Rectal Cancer
    • Adjuvant therapy for resectable synchronous metastases that are pT1-2, N0, M1 changed from recommendations on REC-4 to FOLFOX or CapeOx preferred.
  • Colon and Rectal Cancer
    • Adjuvant therapy for resectable metachronous metastases with no previous chemotherapy changed from recommendations on COL-4/REC-4 to FOLFOX or CapeOx preferred.
    • Following resection of resectable metachronous metastases with previous chemotherapy, the following information added to observation: "preferred for previous oxaliplatin-based chemotherapy"
    • Chemotherapy for advanced or metastatic disease
      • Therapy after first progression on oxaliplatin-based therapy
        • "± bevacizumab" added to FOLFIRI and to irinotecan.
        • FOLFIRI ± ziv-aflibercept added as a treatment option.
        • Irinotecan ± ziv-aflibercept added as a treatment option.
      • Therapy after first progression on irinotecan-based therapy: "± bevacizumab" added to FOLFOX and to CapeOx.
      • Therapy after first progression on fluoropyrimidine-based therapy
        • "± bevacizumab" added to FOLFOX, CapeOx, FOLFIRI, irinotecan, and irinotecan + oxaliplatin.
        • FOLFIRI ± ziv-aflibercept added as a treatment option.
        • Irinotecan ± ziv-aflibercept added as a treatment option.
      • The following footnote added: "There are no data to suggest activity of FOLFIRI-aflibercept in a patient who has progressed on FOLFIRI-bevacizumab, or vice versa. Ziv-aflibercept has only shown activity when given in conjunction with FOLFIRI in FOLFIRI-naïve patients.

 

For the complete updated version of these and all NCCN Guidelines, visit NCCN.org.