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NCCN Flash UpdatesTM: NCCN Guidelines® and NCCN Compendium® Updated

NCCN has published updates to the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) and the NCCN Drugs & Biologics Compendium (NCCN Compendium®) for Bladder Cancer. These NCCN Guidelines® are currently available as Version 1.2015.

  • Posttreatment cTa, cT1, Tis recurrent or persistent disease (BL-3)
    • Maintenance BCG therapy was changed from “optional” to “preferred” when BCG has been previously given.
  • Clinical Stage T2, T3, T4a, negative nodes (BL-4, 5)
    • Primary treatment for patients with extensive comorbid disease or poor performance status, the following treatment modifications were made, Chemotherapy alone was removed and RT alone was added as an option.
    • Adjuvant treatment for patients with extensive comorbid disease or poor performance status, unresectable or not a surgical candidate, the treatment was revised to, “Consider RT if not previously given and/or Alternate chemoradiotherapy, or TURBT and Best supportive care.”
  • Follow-up for muscle invasive and selected metastatic disease treated with curative intent (BL-7)
    • A new footnote “s” was added, “No single follow-up plan is appropriate for all patients. Follow-up should be individualized based on treatment schedules, side effects, comorbidities, and symptoms.”
    • For local recurrence or persistent disease; preserved bladder, invasive disease, “RT (if no prior RT)” was changed to “Chemoradiotherapy (if no prior RT).”
  • Principles of Chemotherapy Management (BL-G 3 of 4)
    • For radiosensitizing chemotherapy regimens for bladder-preserving chemoradiation following a maximal TURBT, low-dose gemcitabine was added as a category 2B recommendation.
    • For radiosensitizing chemotherapy given concurrently with conventionally fractionated radiation for palliation of metastases or for pelvic recurrence after cystectomy, low-dose gemcitabine was changed from a category 3 to a category 2B recommendation.
  • Principles of Radiation Management of Invasive Disease, Carcinoma of the Bladder (BL-H 1 of 2)
    • A new principle was added, “When irradiating the bladder only or bladder tumor boost, consider daily image guidance.”
  • Primary Carcinoma of the Urethra (PCU-2)
    • T2 disease
      • Male, bulbar urethra, adjuvant treatment options, “Consider adjuvant chemotherapy + RT” was changed to “Consider adjuvant chemotherapy or chemoradiotherapy.”
      • Female, therapy for recurrence, “or chemoradiotherapy” was added to “chemotherapy.”
    • T3, T4 disease and Palpable inguinal lymph nodes
      • cN1/cN2, primary treatment, “or chemoradiotherapy” was added to “chemotherapy.”
      • Therapy for recurrence, “or chemoradiotherapy” was added to “chemotherapy.”
    • Distant metastases
      • Primary treatment, “or chemoradiotherapy” was added to “chemotherapy”
      • Footnote “c” was revised by adding, “consider neoadjuvant chemotherapy (category 2B) or chemoradiation.”

For the complete updated versions of the NCCN Guidelines, 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 iPhone, iPad, and Android devices are now available! Visit

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