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NCCN Flash Update: NCCN Guidelines & NCCN Compendium for Testicular Cancer

NCCN has published updates to the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) and the NCCN Drugs & Biologics Compendium (NCCN Compendium®) for Testicular Cancer. These NCCN Guidelines® are currently available as Version 1.2018.

  • Global Changes
    • AJCC Cancer Staging tables (7th edition): Following statement added, "Both the AJCC Staging for Testis Cancer 7th and 8th editions are included for reference and documentation." (ST-1 and ST-2)
    • The AJCC Cancer Staging tables (8th edition) for Testis Cancer were added (ST-3, ST-4, ST-5).
  • Primary Treatment or a suspicious testicular mass (TEST-1)
    • Sub-bullets were revised under “Consider inguinal biopsy of contralateral testis if:”
      • Suspicious Ultrasound showing with intratesticular abnormalities mass concerning for testicular cancer.”
      • New sub-bullet added "Suspicious mass"
  • Pure Seminoma
    • Postdiagnostic workup (TEST-2)
      • Last bullet revised to “"Discuss Recommend sperm banking, if clinically indicated."
      • Footnote “g” regarding repeat markers was revised, “...to allow precise staging. Follow declining markers until normalization or plateau. Staging is based on marker levels at the time that the patient starts postorchiectomy therapy (for example, for patients starting chemotherapy for disseminated disease, prognostic category and staging should be assigned based on the serum tumor marker levels on day 1 of cycle 1 of chemotherapy)
      • Footnote "j" regarding Clinical Stage IA, IB is new: "The panel recommends using the AJCC Staging 7th edition for subclassifying and making treatment decisions about stage I tumors. (See ST-1 and ST-2)".  This footnote was also added for Nonseminoma Stages IA, IB (TEST-6)
    • Primary Treatment (TEST-4)
      • Stage IIA: Revised to "Primary chemotherapy: BEP for 3 cycles or EP for 4 cycles for multiple positive lymph nodes"
      • Stage IIC, III: Footnote “u” regarding Intermediate Risk is new: "Intermediate risk in seminoma is based on metastases to organs other than the lungs (stage IIIC). Stage IIIB does not apply to pure seminomas. Patients with elevated AFP have nonseminomas and patients with a serum bHCG above 1000 IU/L are also generally presumed to have a nonseminoma. LDH should not be used to stage or risk stratify patients with pure seminoma."
    • Stage IIA, IIB, IIC, III After Primary Treatment With Chemotherapy (TEST-5)
      • For patients with a residual mass (>3 cm) and normal serum AFP and beta-hCG, “Surveillance” was added as an option and the imaging recommendation was revised: "Consider PET/CT scan from skull base to mid-thigh (6 wks...)."
  • Nonseminoma
    • Primary Treatment
      • Stage IB recommendations were revised: (TEST-7)
        • "Primary chemotherapy: BEP for 1–2 1 cycle"
        • "Surveillance for T2 or T3 (category 2B)"
      • Intermediate risk Stage IIIB: “VIP for 4 cycles” changed from category 2A to category 1. (TEST-11)
      • After primary treatment for Stages IS-IIIC, a new pathway was added for “Incomplete response with persistently elevated AFP and/or beta-hCG levels” followed by a new “Post-chemotherapy Management” section for this group of patients. (TEST-11)
    • Second-Line Therapy (TEST-12)
      • For patients who received prior chemotherapy, “Recommend sperm banking if clinically indicated" was added as an option
      • For patients who received no prior chemotherapy, "Discuss Recommend sperm banking if clinically indicated"
    • Post Second-Line Therapy (TEST-13)
      • A new page was added with treatment options for recurrence for patients who had received prior second-line therapy
    • Third-Line Therapy (TEST-14)
      • A new third-line therapy page was added with treatment options for recurrence for patients who had received prior chemotherapy.
  • Follow-up for Seminoma (TEST-A 2 of 2)
    • Table 4: The imaging time interval recommendations for "Abdominal/Pelvic CT" was revised for all years.
      • Two new footnotes were added regarding “Abdominal/Pelvic CT”: “Patients with residual masses may require more frequent imaging based on clinical judgment." and “PET/CT scan skull base to mid-thigh as clinically indicated."
  • Primary Chemotherapy Regimens for Germ Cell Tumors (TEST-E)
    • EP: Added "(Option only for good-risk patients [see TEST-D], patients with pathologic stage II disease, and patients with viable GCT at surgery following first-line chemotherapy)"
    • VIP: Added "(Option only for intermediate or poor-risk patients or patients with viable GCT at surgery following first-line chemotherapy (See TEST-5 and TEST-11)"
    • VIP: Mesna dose was revised.
    • New footnote "3" added for VIP, TIP, VeIP: "These regimens are high risk for febrile neutropenia and granulocyte colony-stimulating factors (G-CSF) should be used (See NCCN Guidelines for Myeloid Growth Factors).
  • Second-Line Chemotherapy Regimens for Metastatic Germ Cell Tumors (TEST-F)
    • Mesna dose revised for VeIP and TIP.
  • Third-Line Chemotherapy Regimens for Metastatic Germ Cell Tumors (TEST-G)
    • Page title revised: "Subsequent Third-Line Chemotherapy Regimens For Metastatic Germ Cell Tumors"
    • Palliative Chemotherapy Regimens: "Pembrolizumab (for MSI-H/dMMR tumors)" added as an option.
  • Principles of Surgery for Germ Cell Tumors (TEST-H)
    • First bullet revised, "... and post-chemotherapy setting. Referral to high-volume centers with experience in performing RPLNDs should be considered."

For the complete updated versions of the NCCN Guidelines, NCCN Guidelines with NCCN Evidence Blocks™, the NCCN Drugs & Biologics Compendium (NCCN Compendium®), the NCCN Biomarkers Compendium®, the NCCN Chemotherapy Order Templates (NCCN Templates®), the NCCN Radiation Therapy Compendium™, and the NCCN Imaging Appropriate Use Criteria (NCCN Imaging AUC™), please visit NCCN.org.

To view the NCCN Guidelines for Patients®, please visit NCCN.org/patients.

Free NCCN Guidelines apps for iPhone, iPad, and Android smartphones & tablets are now available! Visit NCCN.org/apps

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