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NCCN Flash Updates: NCCN Guidelines®, NCCN Compendium®, and NCCN Templates® for Testicular Cancer

NCCN has published updates to the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®), the NCCN Drugs & Biologics Compendium (NCCN Compendium®), and the NCCN Radiation Therapy Compendium™ for Testicular Cancer. These NCCN Guidelines® are currently available as Version 1.2019.

  • Testicular Cancer
    • Global Changes
      • The NCCN Categories of Preference have been applied to all of the suggested treatment regimens.
      • Stage IA and IB Nonseminoma were changed to “Stage I without risk factors” and “Stage I with risk factors,” respectively.
      • The following footnote was removed: “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).”
      • Principles of Imaging (TEST-I) is new.
      • The discussion section has been updated to reflect the changes in the algorithm.
    • Pure Seminoma
      • Stage I Primary Treatment (TEST-3)
        • Category 1 was removed from Surveillance for pT1-pT3 tumors.
        • Footnote l was revised: “Recommend chest/abdominal/pelvic CT scan and chest x-ray or CT scan within the 4 weeks prior to the initiation of chemotherapy to confirm staging, even is scan was done previously. See Principles of Imaging (TEST-I).”
      • Stage II and III Primary Treatment (TEST-4)
        • Footnote w is new: “Consider a bleomycin-free regimen in patients with reduced or borderline GFR and in patients over the age of 50.”
      • Stage IIA, IIB, IIC, III After Primary Treatment with Chemotherapy (TEST-5)
        • Follow-up for "Positive for viable seminoma" split into two pathways: "Complete resection" and "Incomplete resection or Progression".
          • "2 cycles adjuvant chemotherapy" was added after "Complete resection."
        • Footnote x is new: “If PET/CT is borderline, consider surveillance and repeat PET/CT. See Principles of Imaging (TEST-I).”
      • Follow-up for Seminoma (TEST-A)
        • Footnote e is new: “In select circumstances, an MRI can be considered to replace an abdominal/pelvic CT. The MRI protocol should include all the nodes that need to be assessed. The same imaging modality (CT or MRI) should be used throughout surveillance. See Principles of Imaging (TEST-I).
      • Principles of Radiotherapy for Pure Testicular Seminoma was extensively reorganized (TEST-C)
    • Nonseminoma
      • Postdiagnostic Workup and Clinical Stage (TEST-6)
        • Footnote dd is new: “Risk factors include lymphovascular invasion or invasion of the spermatic cord or scrotum.”
      • Stage I Primary Treatment (TEST-7)
        • Stage I with risk factors: "category 2B" was removed from Surveillance.
        • Footnote ee is new: “Treatment options listed based on preference, see Discussion.”
      • Stage IIA and IIB Primary Treatment (TEST-8)
        • Stage IIA, Markers negative: "category 2B" was removed from Primary chemotherapy.
      • Post-Chemotherapy Management after Partial or Incomplete Response (TEST-12)
        • Footnote pp is new: “Consider EP for low-volume residual disease.”
      • Third-Line Therapy After Recurrence (TEST-15)
        • Third-Line Therapy for "Prior high-dose chemotherapy": "MMR testing" was added.
      • Follow-up for Nonseminoma (TEST-B)
        • Footnote c is new: “In select circumstances, an MRI can be considered to replace an abdominal/pelvic CT. The MRI protocol should include all the nodes that need to be assessed. The same imaging modality (CT or MRI) should be used throughout surveillance. See Principles of Imaging (TEST-I).”
        • Footnote e is new: “Optional for patients treated with primary RPLND.”
        • Footnote f was revised: "Patients who undergo RPLND and are found to have pN0 disease (no tumor or teratoma) need only 1 CT scan at postoperative month 3–4 and then as clinically indicated.”
      • TEST-B (1 of 3)
        • Table 5: Abdominal ± Pelvic CT interval for years 4 and 5 updated to "As clinically indicated".
        • Table 6
          • Abdominal ± pelvic CT interval for year 5 updated to "As clinically indicated"
          • Chest x-ray intervals were updated to be consistent with abdominal ± pelvic CT intervals.
      • TEST-B (2 of 3): Table 7, "or Primary RPLND" was added to title.
      • TEST-B (3 of 3): Table 10, Abdominal/Pelvic CT interval for year 2 was updated: " Annually  As clinically indicated "
    • Third-Line Chemotherapy Regimens for Metastatic Germ Cell Tumors (TEST-G)
      • Footnote a is new: “If VIP or TIP received as second-line therapy, high-dose chemotherapy is the preferred third-line option.”

NCCN has published updates to the NCCN Templates® for Testicular Cancer to reflect the currently published NCCN Guidelines for Testicular Cancer v1.2019.

  • Indications have been updated on the following templates:
  • TES3: TIP (PACLitaxel/Ifosfamide/CISplatin)
  • TES5: EP (CISplatin/Etoposide)
  • TES6: VeIP (VinBLAStine/Ifosfamide/Mesna/CISplatin)
  • TES9: VIP (Etoposide/Ifosfamide/Mesna/CISplatin)
  • TES14: Pembrolizumab

 

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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