eBulletin Newsletter

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

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 1.2020.

  • Bladder Cancer
    • Global Changes
      • "FDG" was added at each mention of "PET/CT" throughout the Guidelines.
    • Clinical Presentation and Initial Evaluation (BL-1)
      • Initial Evaluation: The last bullet is new: “Screen for smoking (See NCCN Guidelines for Smoking Cessation)”
      • Primary Evaluation/Surgical Treatment
        • "especially in bladder preservation" was removed from the 4th bullet
        • "Consider transurethral biopsy of prostate" was removed as a sub bullet
      • Footnote a is new: "For tools to aid optimal assessment and management of older adults with cancer, see NCCN Guidelines for Older Adult Oncology."
    • Secondary Surgical Treatment, Adjuvant Intravesical Treatment, Follow-up (BL-2)
      • Adjuvant Intravesical Treatment, cTa, low grade: "Intravesical chemotherapy" changed to "Intravesical therapy"
        • Footnote l is new: "Intravesical chemotherapy is preferred, although BCG may be considered when not in shortage."
      • Footnote n was updated: "Cystectomy is generally reserved for residual T1, high-grade, and muscle-invasive disease at re-resection, and variant histology associated with adverse outcomes."
      • "low grade" was added to footnote o.
    • Posttreatment cTa, cT1, Tis Recurrent or Persistent Cancer (BL-3)
      • Treatment
        • "T2 or higher" pathway is new.
      • Footnote d was updated: "Immediate intravesical chemotherapy reduces the recurrence rate by 35%. Most efficacious in patients with low grade, low-volume Ta urothelial cancer. See Principles of Intravesical Treatment (BL-F)."
    • Cytology Positive, Imaging Negative, Cystoscopy Negative Evaluation and Treatment (BL-4)
      • Evaluation: The last bullet is new, "Consider enhanced cystoscopy (if available)"
    • Stage II (cT2, N0) Primary and Adjuvant Treatment (BL-5)
      • Adjuvant Treatment of Cystectomy candidates was updated (also for BL-7):
        • "Based on pathologic risk (pT3-4 or positive nodes or positive margins)..."
        • "Consider adjuvant RT" is now a category 2B recommendation
    • Stage II (cT2, N0) Non-Cystectomy Candidates (BL-6)
      • Primary Treatment
        • "Concurrent chemoradiotherapy" is now a preferred, category 1 recommendation. Also for BL-7
        • "and consider intravesical BCG" was removed from TURBT
      • Adjuvant Treatment
        • "Tumor pathway"
          • "or RT alone" was added to "Concurrent chemoradiotherapy"
    • Stage IIIA (cT3, N0; cT4a, N0; cT1-cT4a, N1) Primary and Adjuvant Treatment (BL-7)
      • Primary Treatment: "Cystectomy alone for those not eligible to receive cisplatin-based chemotherapy" is new.
      • Footnote x was updated: "Cystectomy alone is appropriate for those not eligible to receive cisplatin-based chemotherapy. Patients with cN1 disease do better have better outcomes if there is a response to they are given neoadjuvant chemotherapy and have than if there is a response to surgery alone."
    • Stage IIIB (cT1-cT4a, N2,3) Primary and Subsequent Treatment (BL-8)
      • Additional Workup: "Consider" was added to the last bullet.
    • Stage IVA (cT4b, Any N, M0; Any T, Any N, M1a) Primary and Subsequent Treatment (BL-9)
      • M1a disease:
        • "Concurrent chemoradiotherapy" was moved from Primary Treatment to Subsequent Treatment as an option for CR
      • Subsequent Treatment
        • No tumor pathway: "Completion of definitive RT" was removed.
        • Stable Disease or Progression was updated: "See Treatment of Recurrent or Persistent Disease Treat as metastatic disease"
    • Metastatic Disease, Additional Workup, Primary Treatment (BL-10)
      • "Molecular/genomic testing" was added to Additional Workup
      • "and/or Palliative RT" was added to Primary Treatment
      • "Consider" was removed from footnote cc.
      • Footnote dd is new: "For patients with borderline GFR, consider timed urine collection which may more accurately determine eligibility for cisplatin."
    • Follow-up, Recurrent or Persistent Disease (BL-11)
      • Treatment of Recurrent or Persistent Disease
        • "Systemic therapy" was added as an option for muscle invasive.
        • Recommendations for Tis, Ta, or T1 were updated: “Consider intravesical therapy BCG or Cystectomy or TURBT”
    • Principles of Imaging for Bladder/Urothelial Cancer (BL-A)
      • 1 of 5
        • Abdominal and Pelvic Imaging: "Ureteroscopy" was removed as a sub bullet from Staging.
      • 2 of 5
        • The following bullet was removed from chest imaging: "Chest imaging may be performed with plain film radiography with posteroanterior (PA) and lateral views in early-stage disease. If an abnormality is seen, then CT of the chest may then be performed."
        • Staging
          • "or" was removed from the first sub bullet. Also for Follow-up with or without cystectomy and Follow-up of T4b and metastatic disease.
          • 2nd sub bullet was updated: "CT of the chest with or without contrast (preferred) Chest CT with IV contrast could be considered in patients undergoing concurrent imaging of the abdomen and pelvis."
        • Follow-up with or without cystectomy, 2nd sub bullet was updated: "Chest CT with or without IV contrast (preferred)" Also for Follow-up of T4b and metastatic disease.
      • 4 of 5
        • Follow-up, Low risk: "1-to-2-year follow-up" was removed.
    • Principles of Surgical Management (BL-B)
      • 1 of 4
        • TURBT for Staging, last bullet: "and visibly complete resection" was added.
      • 2 of 4
        • TUR of the Urethral Tumor, last bullet was updated: "Consider postsurgical intraurethral therapy is recommended"
    • Principles of Pathology Management (BL-C) was extensively revised.
    • Bladder Cancer: Non-Urothelial and Urothelial with Variant Histology (BL-D, 1 of 2)
      • Any Small-Cell Component (or neuroendocrine features), first bullet: "Concurrent chemoradiotherapy or" was added.
    • Principles of Intravesical Treatment (BL-F, 2 of 3)
      • "Intrapelvic" was removed from "Postsurgical Therapy for Upper Tract Tumors heading.
        • "intrapelvic therapy" was added to the first bullet and subsequent sub bullets
        • The 2nd bullet is new: "Perioperative intravesical chemotherapy with mitomycin or gemcitabine may be given following nephroureterectomy with cuff of bladder resection."
    • Principles of Systemic Therapy (BL-G)
      • 1 of 7
        • 3rd bullet was updated: "Meta-analysis suggests a overall survival benefit to with adjuvant cisplatin-based chemotherapy for pathologic T3, T4 or N+ disease at cystectomy, if it was not given as neoadjuvant."
        • 7th bullet was updated: "For gemcitabine/cisplatin, both a 21-day cycle is preferred. and 28-day regimens are acceptable. Better dose..."
        • "Consider timed urine collection which may more accurately determine eligibility for cisplatin." was added to the last bullet
      • 2 of 7
        • "SP142 assay" added to footnote a.
        • "22C3 antibody assay" added to footnote b.
      • 3 of 7
        • Title of both tables was changed from "Subsequent" to "Second-line"
        • The following regimens were removed from this page: albumin-bound paclitaxel, pemetrexed, ifosfamide, and methotrexate
        • Erdafitinib was added as an Other Recommended treatment option in the bottom table.
        • Footnote c was updated: "If PFS >12 months after platinum (eg, cisplatin or carboplatin) more than 12 months ago, consider..."
        • References 20, 25, and 26 are new.
      • 4 of 7
        • The subsequent-line systemic therapy for locally advanced or metastatic disease (Stage IV) table is new.
        • Footnote e is new: "Patient should have already received platinum and a checkpoint inhibitor, if eligible."
      • 5 of 7
        • Title of bottom table was updated: "Radiosensitizing chemotherapy given concurrently with conventionally fractionated radiation for with palliative intent for regional disease of metastases or recurrence"
        • Reference 29 is new.
    • Principles of Radiation Management of Invasive Disease (BL-H)
      • 13th bullet, postoperative adjuvant pelvic RT is now a category 2B recommendation.
  • Upper GU Tract Tumors
    • UTT-1
      • Workup: "(<60 y at presentation, personal history of colon/endometrial cancer)" was added to the last bullet.
    • UTT-3
      • Follow-up, pT0, pT1
        • "and consider cytology for high grade" was added to the first bullet.
        • 2nd bullet was updated: "If nephron-sparing surgery endoscopic resection..." Also for pT2, pT3, pT4, pN+.
        • pT2, pT3, pT4, pN+: "and cytology" was added to the first bullet.
  • Primary Carcinoma of the Urethra
    • PCU-2
      • "with cystoscopy" was added to Follow-up imaging throughout
      • Male
        • Pendulous urethra: "Negative margin" pathway was added.
        • Bulbar urethra: "pT1/pT2 and pN0" pathway was added.
      • Primary Treatment for T2, female: "Distal urethrectomy (depending on tumor location)" was added.
    • PCU-3
      • cN0, Primary Treatment
        • "(if urothelial carcinoma)" added to Neoadjuvant chemotherapy.
        • "Consolidative surgery alone for non-urothelial histology" was added.

 

NCCN has published updates to the NCCN Chemotherapy Order Templates (NCCN Templates®) for Bladder Cancer to reflect the NCCN Guidelines for Bladder Cancer v1.2020.

The following NCCN Templates have been removed:

  • BLA16: Ifosfamide
  • BLA25: PEMEtrexed
  • BLA34: Methotrexate
  • BLA58: Albumin-bound PACLitaxel

 

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..

3025 Chemical Road, Suite 100, Plymouth Meeting, PA 19462
Phone: 215-690-0300
Fax: 215-690-0280
Copyright © National Comprehensive Cancer Network, All Rights Reserved.

No portion of this Site or any NCCN Content may be copied, transferred, reproduced, modified, or otherwise used for any purpose without NCCN’s express written permission.
See Legal Notices Section for additional notices and terms governing your use of this Site.