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NCCN Flash Update: Updated NCCN Guidelines, NCCN Compendium, NCCN Templates, and NCCN Biomarkers Compendium

NCCN has published updates to the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®), NCCN Drugs & Biologics Compendium (NCCN Compendium®), and the NCCN Radiation Therapy Compendium™ for Thymomas and Thymic Carcinomas. These NCCN Guidelines® are currently available as Version 1.2018.

  • Initial Evaluation (THYM-1)
    • Thymic tumor unlikely: Consider tissue biopsy added.
       
  • Principles of Surgical Resection (THYM-A)
    • Bullet 7 is new to the page: Surgical clips should be placed at the time of resection to areas of close margins, residual disease, or tumor adhesion to unresected normal structures to help guide accurate radiation therapy when indicated.
       
  • Principles of Radiation Therapy (THYM-B 1 of 3)
    • General Principles
      • Bullet 4 modified: The review of preoperative imaging and co-registration of preoperative imaging into the planning system may be are helpful in defining treatment volumes.
    • Radiation Doses
      • Last bullet added: Depending on the treatment objectives in the palliative setting, typical palliative doses (e.g., 8 Gy single fraction, 20 Gy in 5 fractions, 30 Gy in 10 fractions) up to definitive doses for more durable local control and highly conformal techniques for limited volume metastases may be appropriate, given the relatively long natural history of even metastatic thymoma.
         
  • Principles of Chemotherapy (THYM-C)
    • VIP regimen name replaced with “Etoposide/Ifosfamide/Cisplatin.”
       
  • WHO Classification information has been updated (THYM-D)
     
  • Staging updated to reflect the changes in the AJCC Cancer Staging Manual, Eighth Edition (2017). (ST-2)

 

 

NCCN has published NCCN Chemotherapy Order Templates (NCCN Templates®) for Colon Cancer to reflect the currently published NCCN Guidelines for Colon Cancer, Version 1.2018.

  • The following NEW NCCN Templates® have been published:
    • COL50: Regorafenib
    • COL51: Irinotecan + Panitumumab
    • COL52: FOLFIRI (Fluorouracil Continuous Infusion/Leucovorin/Irinotecan) + Ziv-aflibercept
    • COL53: Irinotecan + Ziv-aflibercept
    • COL54: Irinotecan + Bevacizumab
    • COL55: IROX (OXALIplatin/Irinotecan) + Bevacizumab
    • COL57: FOLFOXIRI (Fluorouracil Continuous Infusion/OXALIplatin/Irinotecan) + Bevacizumab
    • COL58: Irinotecan Every 14 Days
    • COL60: Trifluridine and Tipiracil
    • COL61: FOLFIRI (Fluorouracil Continuous Infusion/Leucovorin/Irinotecan) + Ramucirumab
    • COL62: Irinotecan Every 14 Days + Ramucirumab
    • COL63: Pembrolizumab
    • COL64: Nivolumab
    • COL65: mFOLFOX7 (Fluorouracil Continuous Infusion/Leucovorin/OXALIplatin)
    • COL66: Irinotecan + Cetuximab + Vemurafenib
    • COL67: Irinotecan + Panitumumab + Vemurafenib

NCCN has published updates to the NCCN Templates for Testicular Cancer to reflect the currently published NCCN Guidelines for Testicular Cancer, Version 1.2018.

  • The following NEW NCCN Template has been published:
    • TES14: Pembrolizumab

 

  • Indications for all testicular cancer templates have been revised to be more specific.

 

  • A new reference has been added to the following template: Reference #3. Mulherin BP, et al. Am J Clin Oncol. 2015;38(4)373-6.
    • TES10: Gemcitabine/PACLitaxel

 

  • Cycle information for the following template has been revised to “21-day cycle for 4 cycles (primary: seminoma) or 2 – 4 cycles (primary: nonseminoma) or 2 cycles (residual: seminoma or residual: nonseminoma)”
    • TES5: EP (CISplatin/Etoposide)

 

  • The following note for regimens with a high risk of febrile neutropenia has been updated in the Myeloid Growth Factor Therapy section: “Filgrastim or tbo-filgrastim or filgrastim-sndz 5 mcg/kg subcutaneously daily recommended to start the day following or up to 3 – 4 days after completion of chemotherapy and to continue until post-nadir ANC recovery to normal or near-normal levels by laboratory standards. Dose is rounded to the nearest vial size by institution-defined weight limits. Same-day administration is not recommended. OR Pegfilgrastim 6 mg subcutaneously once per treatment cycle recommended to be given the day following or up to 3 – 4 days after completion of chemotherapy. There are insufficient data to support use of pegfilgrastim for cytotoxic chemotherapy regimens administered less frequently than every 2 weeks. Same-day administration is not recommended.”
    • TES1: BEP (Bleomycin/Etoposide/CISplatin)
    • TES3: TIP (PACLitaxel/Ifosfamide/CISplatin)
    • TES6: VelP (VinBLAStine/Ifosfamide/Mesna/CISplatin)
    • TES9: VIP (Etoposide/Ifosfamide/Mesna/CISplatin)

 

  • The following NEW note for CARBOplatin has been added to the Monitoring and Hold Parameters section: “Electrolytes (eg, magnesium, potassium) should be monitored as clinically indicated.”
    • TES7: CARBOplatin

 

  • The following NEW note for CARBOplatin, CISplatin, PACLitaxel, and vinBLAStine has been added to the Monitoring and Hold Parameters section: “This agent may cause peripheral neuropathy. Monitor patients as clinically indicated for persistent issues with altered sensation including pain or discomfort and/or regional motor weakness that may interfere with activities of daily living. Dose modification or discontinuation of therapy may be warranted.”
    • TES1: BEP (Bleomycin/Etoposide/CISplatin)
    • TES3: TIP (PACLitaxel/Ifosfamide/CISplatin)
    • TES5: EP (CISplatin/Etoposide)
    • TES6: VelP (VinBLAStine/Ifosfamide/Mesna/CISplatin)
    • TES7: CARBOplatin
    • TES9: VIP (Etoposide/Ifosfamide/Mesna/CISplatin)
    • TES10: Gemcitabine/PACLitaxel
    • TES11: Gemcitabine/PACLitaxel/OXALIplatin

 

  • The following note for CISplatin and PACLitaxel has been deleted from the Monitoring and Hold Parameters section: “Signs and symptoms of neurotoxicity should be monitored as clinically indicated for potential dose modification or discontinuation.” (replaced with the more specific peripheral neuropathy note above)
    • TES3: TIP (PACLitaxel/Ifosfamide/CISplatin)
    • TES10: Gemcitabine/PACLitaxel
    • TES11: Gemcitabine/PACLitaxel/OXALIplatin

 

  • The following NEW note for gemcitabine has been added to the Safety Parameters and Special Instructions section: “This agent is an irritant.”
    • TES10: Gemcitabine/PACLitaxel
    • TES11: Gemcitabine/PACLitaxel/OXALIplatin

 

  • The following note for PACLitaxel has been updated in the Safety Parameters and Special Instructions section: “This agent should be prepared either in glass or non-PVC containers and administered through non-PVC tubing and a low protein binding 0.2 or 0.22 micron in-line filter.”
    • TES3: TIP (PACLitaxel/Ifosfamide/CISplatin)
    • TES10: Gemcitabine/PACLitaxel
    • TES11: Gemcitabine/PACLitaxel/OXALIplatin

 

  • The following NEW notes for vinBLAStine have been added to the Safety Parameters and Special Instructions section: “VinBLAStine is for IV use only and usually results in death or serious neurological damage if given via other routes.” and “VinBLAStine should be administered via a minibag (eg, 25 mL – 50 mL).”
    • TES6: VelP (VinBLAStine/Ifosfamide/Mesna/CISplatin)

NCCN has published updates to the NCCN Templates for Uterine Neoplasms to reflect the currently published NCCN Guidelines for Uterine Neoplasms. Version 1.2018.

  • The following NEW NCCN Templates have been published:
    • UTE17: Everolimus + Letrozole
    • UTE18: Albumin-bound PACLitaxel
    • UTE19: Pembrolizumab
    • UTS17: Trabectedin
    • UTS18: DOXOrubicin + Olaratumab

 

  • Indications and cycle information for all endometrial carcinoma and uterine sarcoma templates have been revised.

 

  • References have been updated on the following templates:

 

  • UTE4: DOCEtaxel/CARBOplatin
  • UTE5: Liposomal DOXOrubicin
  • UTE6: DOXOrubicin
  • UTE11: PACLitaxel
  • UTS1: Gemcitabine/DOCEtaxel
  • UTS3: Ifosfamide
  • UTS5: Dacarbazine

 

  • The febrile neutropenia risk on template UTE4: DOCEtaxel/CARBOplatin has been updated to “Intermediate”.

 

  • The dosing for template UTE5: Liposomal DOXOrubicin has been updated to a range of 40-50 mg/m2.

 

  • A new dosing option has been added to the following templates:
    • UTS3: Ifosfamide
    • UTS5: Dacarbazine

 

  • The following note for regimens with a high risk of febrile neutropenia has been updated in the Myeloid Growth Factor Therapy section: “Filgrastim or tbo-filgrastim or filgrastim-sndz 5 mcg/kg subcutaneously daily recommended to start the day following or up to 3 – 4 days after completion of chemotherapy and to continue until post-nadir ANC recovery to normal or near-normal levels by laboratory standards. Dose is rounded to the nearest vial size by institution-defined weight limits. Same-day administration is not recommended. OR Pegfilgrastim 6 mg subcutaneously once per treatment cycle recommended to be given the day following or up to 3 – 4 days after completion of chemotherapy. There are insufficient data to support use of pegfilgrastim for cytotoxic chemotherapy regimens administered less frequently than every 2 weeks. Same-day administration is not recommended.”
    • UTS2: DOCEtaxel
    • UTS6: DOXOrubicin
    • UTS11: DOXOrubicin/Ifosfamide

 

  • The following NEW note for CARBOplatin has been added to the Monitoring and Hold Parameters section: “Electrolytes (eg, magnesium, potassium) should be monitored as clinically indicated.”
    • UTE3: PACLitaxel/CARBOplatin
    • UTE4: DOCEtaxel/CARBOplatin
    • UTE10: CARBOplatin

 

  • The following NEW note for CARBOplatin, CISplatin, DOCEtaxel, eriBULin, PACLitaxel, and vinORELBine has been added to the Monitoring and Hold Parameters section: “This agent may cause peripheral neuropathy. Monitor patients as clinically indicated for persistent issues with altered sensation including pain or discomfort and/or regional motor weakness that may interfere with activities of daily living. Dose modification or discontinuation of therapy may be warranted.”
    • UTE1: DOXOrubicin/CISplatin/PACLitaxel
    • UTE2: DOXOrubicin/CISplatin
    • UTE3: PACLitaxel/CARBOplatin
    • UTE4: DOCEtaxel/CARBOplatin
    • UTE7: DOCEtaxel
    • UTE9: CISplatin
    • UTE10: CARBOplatin
    • UTE11: PACLitaxel
    • UTE12: Ifosfamide/PACLitaxel
    • UTE14: Ifosfamide/CISplatin
    • UTS1: Gemcitabine/DOCEtaxel
    • UTS2: DOCEtaxel
    • UTS14: Gemcitabine/VinORELBine
    • UTS15: VinORELBine
    • UTS16: EriBULin

 

  • The following note for CISplatin, DOCEtaxel, eriBULin, and PACLitaxel has been deleted from the Monitoring and Hold Parameters section: “Signs and symptoms of neurotoxicity should be monitored as clinically indicated for potential dose modification or discontinuation.” (replaced with the more specific peripheral neuropathy note above)
    • UTE1: DOXOrubicin/CISplatin/PACLitaxel
    • UTE2: DOXOrubicin/CISplatin
    • UTE3: PACLitaxel/CARBOplatin
    • UTE4: DOCEtaxel/CARBOplatin
    • UTE7: DOCEtaxel
    • UTE9: CISplatin
    • UTE11: PACLitaxel
    • UTE12: Ifosfamide/PACLitaxel
    • UTE14: Ifosfamide/CISplatin
    • UTS1: Gemcitabine/DOCEtaxel
    • UTS2: DOCEtaxel
    • UTS16: EriBULin

 

  • The following NEW note for dacarbazine has been added to the Monitoring and Hold Parameters section: “Liver function should be monitored prior to initiation of therapy and as clinically indicated for potential dose modification or discontinuation.”
    • UTS5: Dacarbazine
    • UTS12: DOXOrubicin/Dacarbazine
    • UTS13: Gemcitabine/Dacarbazine

 

  • The following NEW note for DOCEtaxel has been added to the Monitoring and Hold Parameters section: “This agent may cause changes to fingernails and toenails including color, texture, and shape. This is usually a reversible side effect, but should be monitored throughout treatment.”
    • UTE4: DOCEtaxel/CARBOplatin
    • UTE7: DOCEtaxel
    • UTS1: Gemcitabine/DOCEtaxel
    • UTS2: DOCEtaxel

 

  • The following NEW note for PAZOPanib has been added to the Monitoring and Hold Parameters section: This agent may cause interstitial lung disease. Monitor for nonspecific respiratory signs and symptoms, including hypoxia, pleural effusion, cough, or dyspnea. Modification or discontinuation of therapy may be warranted.”
    • UTS10: PAZOPanib

 

  • The following NEW note for temsirolimus has been added to the Monitoring and Hold Parameters section: “Renal function should be monitored prior to initiation of therapy and as clinically indicated for potential dose modification or discontinuation.”
    • UTE16: Temsirolimus

 

  • The following note for PACLitaxel has been updated in the Safety Parameters and Special Instructions section: “This agent should be prepared either in glass or non-PVC containers and administered through non-PVC tubing and a low protein binding 0.2 or 0.22 micron in-line filter.”
    • UTE1: DOXOrubicin/CISplatin/PACLitaxel
    • UTE3: PACLitaxel/CARBOplatin
    • UTE11: PACLitaxel
    • UTE12: Ifosfamide/PACLitaxel

 

  • The following note for temsirolimus has been updated in the Safety Parameters and Special Instructions section: “This agent should be prepared either in glass or non-PVC containers and administered through non-PVC tubing and a low protein binding ≤5 micron in-line filter.”
    • UTE16: Temsirolimus

 

  • The following NEW note for gemcitabine and topotecan has been added to the Safety Parameters and Special Instructions section: “This agent is an irritant.”
    • UTE15: Topotecan
    • UTS1: Gemcitabine/DOCEtaxel
    • UTS8: Gemcitabine
    • UTS13: Gemcitabine/Dacarbazine
    • UTS14: Gemcitabine/VinORELBine

 

  • The following note for vinORELBine has been updated in the Safety Parameters and Special Instructions section: “VinBLAStine is for IV use only and usually results in death or serious neurological damage if given via other routes.”
    • UTS14: Gemcitabine/VinORELBine
    • UTS15: VinORELBine

 

 

NCCN has published updates to the NCCN Biomarkers Compendium®, based on updates to the following NCCN Guidelines:

  • Bone Cancer, Version 1.2018
  • Cervical Cancer, Version 1.2018
  • Genetic/Familial High Risk Assessment: Breast and Ovarian, Version 1.2018
  • Melanoma, Version 2.2018
  • Multiple Myeloma, Version 3.2018
  • Myeloproliferative Neoplasms, Version 2.2018
  • Occult Primary, Version 1.2018
  • Soft Tissue Sarcoma, Version 1.2018
  • Systemic Light Chain Amyloidosis, Version 1.2018
  • Uterine Neoplasms, Version 1.2018
  • Vulvar Cancer, Version 1.2018

 

For the complete updated versions of the NCCN Guidelines, NCCN Guidelines with NCCN Evidence Blocks™, the NCCN Compendium®, the NCCN Biomarkers Compendium®, the 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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