Facebook Tracking Image

National Comprehensive Cancer Network

About NCCN

NCCN Flash Updates: NCCN Guidelines® and NCCN Compendium® for Occult Primary

NCCN has published updates to the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) and the NCCN Drugs & Biologics Compendium (NCCN Compendium®) for Occult Primary (Cancer of Unknown Primary [CUP]). These NCCN Guidelines® are currently available as Version 1.2020.

  • Localized adenocarcinoma or carcinoma not otherwise specified (OCC-8 and OCC-13)
    • “Unilateral or bilateral” was deleted from “Supraclavicular”
  • Squamous cell carcinoma (OCC-11)
    • “Check results of p16 immunohistochemistry/HPV in situ hybridization and EBV in situ hybridization; positive results can help localize primary site” is a new footnote corresponding to additional workup.
  • Potential Immunohistochemistry Markers for Unknown Primary Cancers (OCC-A, 1 of 5)
    • The following markers are new to the page:
      • EBV; Nasopharynx; Nuclear
      • HPV; Cervix, vulva, vagina, penis, anal, oropharynx; Nuclear (DNA ISH); nuclear/cytoplasmic (RNA ISH)
      • P16; Cervix, vulva, vagina, penis, anal, oropharynx; Nuclear/cytoplasmic (if positive, perform HPV ISH)
    • The following reference is new to the page: Demetri GD, Paz-Ares L, Farago AF, et al. Efficacy and safety for entrectinib in patients with NTRK fusion-positive tumours: pooled analysis of STARTRK-2, STARTRK-1, and Alka-372-001. ESMO Meeting in Munich, Germany; October 12-23, 2018. Oral Presentation.
  • Principles of Chemotherapy and Selected Chemotherapy Regimens (OCC-B, 2 through 9)
    • The NCCN Categories of Preference has been applied to all of the suggested regimens.
      • FOLFIRINOX and pembrolizumab are new to the page for adenocarcinoma that are preference stratified as useful in certain circumstances.
      • Capecitabine and fluorouracil are new to the page for adenocarcinoma and squamous cell carcinoma that are preference stratified as other recommended regimens.
      • “These regimens can be given with concurrent radiation” is a new footnote corresponding to capecitabine, fluorouracil and mFOLFOX6.
      • “Only for patients with performance status ECOG 0–1” is a new footnote corresponding to paclitaxel/carboplatin/etoposide, FOLFIRINOX and docetaxel/cisplatin/fluorouracil.
      • “For patients ineligible to receive platinum-based chemotherapy” is a new footnote corresponding to irinotecan and gemcitabine.
      • “For patients with presumed GI primary site” is a new footnote corresponding to FOLFIRINOX.
      • “Only for patients with MSI-H (or dMMR) tumors” is a new footnote corresponding to pembrolizumab.
      • For adenocarcinoma, the dosing for docetaxel has been modified to 60–75 mg/m2 IV Day 1
      • For squamous cell carcinoma, the dosing for docetaxel has been modified to 60–75 mg/m2 IV Day 1.
      • The following regimen was removed: docetaxel 75 mg/m2 IV Day 1/cisplatin 75 mg/m2 IV Day 1/Repeat cycle every 3 weeks.
      • Fluorouracil and cisplatin with radiation is a new regimen for squamous cell carcinoma that is preference stratified as other recommended regimens.

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/patientguidelines.

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

About NCCN Flash Updates™

NCCN Flash Updates™ is a subscription service from NCCN that provides timely notification of updated and new information appearing in the NCCN Guidelines, the NCCN Compendium®, and other NCCN Content.

Subscribe to NCCN Flash Updates™

Please note: The NCCN Third Party Content FTP site: ftp://ftp1.nccn.org/ThirdPartyContent/ has been updated. Licensees are solely responsible for obtaining permission from such third party to use any such Third Party Content in the Permitted Works.

Access information on permissions and licensing of NCCN Content

Users may unsubscribe from Flash Updates at any time by contacting us. NOTE: The subscription fee for NCCN Flash Updates™ is non-refundable.