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NCCN Flash Updates™: NCCN Guidelines® & NCCN Compendium® Updated

NCCN has published updates to the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) and NCCN Drugs & Biologics Compendium (NCCN Compendium®) for Gastric Cancer. These NCCN Guidelines® are currently available as Version 1.2016.

  • Global Changes
    • Notations for clinical (c), surgical (yp), and pathological (p) staging were added to the tumor classification as appropriate throughout the guidelines.
  • Workup (GAST-1)
    • Seventh bullet revised: "Endoscopic resection (ER) may contribute to accurate staging of early-stage cancers (T1a or T1b)."
    • Twelfth bullet revised: "Smoking cessation advice, counseling, and pharmacotherapy as indicated."
  • Additional Evaluation: Revised recommendation "Consider laparoscopy with cytology." (GAST-1)
  • Postoperative Management (GAST-3)
    • R0 resection for T2, N0 tumors: “Chemotherapy for patients who have undergone primary D2 lymph node dissection” removed as an option.
  • Follow-up/Surveillance (GAST-6)
    • Third bullet revised: "Radiologic imaging or upper GI endoscopy, as clinically indicated."
  • Principles of Systemic Therapy (GAST-F 2 of 11)
    • Preoperative Chemoradiation: "Irinotecan and cisplatin (category 2B)" removed as an option.
    • Perioperative Chemotherapy
      • ECF (epirubicin, cisplatin, and fluorouracil) changed from category 1 to category 2B.
      • ECF modifications changed from category 2A to category 2B for all modifications.
  • Systemic Therapy for Metastatic or Locally Advanced Cancer (where local therapy is not indicated) (GAST-F 3 of 11)
    • First-Line Therapy; Preferred Regimens
      • "DCF (docetaxel, cisplatin, and fluorouracil) (category 1)" removed as an option.
      • The following regimens were removed from the list of "Preferred Regimens" and added to the list of "Other Regimens"
        • DCF modifications
        • ECF (epirubicin, cisplatin, and fluorouracil) (category 1)
        • ECF modifications (category 1)
    • First-Line Therapy; Other Regimens
      • "Docetaxel and irinotecan" removed as an option.
    • The "Alternative Regimens for Consideration" section was removed along with the following systemic therapy options:
      • Mitomycin and irinotecan
      • Mitomycin and fluorouracil
  • Principles of Radiation (GAST-G 3 of 4)
    • Supportive Care: The following bullet removed, "Vitamin B12, iron, and calcium level should be closely monitored, especially for patients receiving postoperative treatment. Monthly B12 shots may be needed because of loss of intrinsic factor. Iron absorption is reduced without gastric acid. Oral supplementation, given with acid such as orange juice, can often maintain adequate levels. Calcium supplementation should also be encouraged."

For the complete updated versions of the NCCN Guidelines, NCCN Guidelines with NCCN Evidence Blocks™, the NCCN Compendium®, and the NCCN Chemotherapy Order Templates (NCCN Templates®), please visit

To access the NCCN Biomarkers Compendium™, please visit

To view the NCCN Guidelines for Patients®, please visit

Free NCCN Guidelines apps for iPhone, iPad, and Android tablets are now available! Visit


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