eBulletin Newsletter

NCCN Flash Updates: NCCN Guidelines^®, NCCN Compendium^®, and NCCN Templates Updated

NCCN has published updates to the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines^®) and NCCN Drugs & Biologics Compendium (NCCN Compendium^®) for Cutaneous Melanoma. These NCCN Guidelines^® are currently available as Version 4.2020.

• Systemic Therapy for Metastatic or Unresectable Disease (ME-I)
  • First-line Therapy
    • Preferred regimens: Third sub-bullet revised as follows, "Combination targeted therapy if BRAF V600- activating mutation; preferred if clinically needed for early response..."
  • Other recommended regimens
    • Based on the new FDA approval, vemurafenib/cobimetinib + atezolizumab was added as a first-line therapy option and preference stratified under the bullet for Other recommended regimens. This regimen is a category 2A recommendation that was clarified as "Combination targeted therapy and anti-PD-L1 therapy if BRAF V600 activating mutation present."
  • Corresponding footnote k for vemurafenib/cobimetinib + atezolizumab was also added: In a randomized, double-blind, placebo-controlled, phase 3 trial, the addition of atezolizumab to vemurafenib and cobimetinib was associated with longer median PFS and longer duration of response; however, the triplet induced more toxicity than the vemurafenib/cobimetinib doublet. Until mature OS data are published, it is not clear that the triplet regimen is preferred over sequential BRAF/MEK inhibitor therapy followed by PD-L1 or PD-1 inhibition.
  • The following footnote was removed: Because BRAF/MEK inhibitors have a shorter time to response compared with checkpoint immunotherapies, they may be preferred in patients with rapidly progressing disease and/or symptoms.

Previous updates to the NCCN Guidelines for Cutaneous Melanoma can be found in the UPDATES section of the current version.

NCCN has published updates to the NCCN Guidelines, the NCCN Compendium^®, and NCCN Imaging Appropriate Use Criteria (NCCN Imaging AUC™) for Systemic Light Chain Amyloidosis. These NCCN Guidelines are currently available as Version 1.2021.

• Systemic Light Chain Amyloidosis Primary Therapy (AMYL-A 1 of 4):
  • Bortezomib/lenalidomide/dexamethasone was added under “Other Recommended Regimens” as a primary therapy for both transplant and non-transplant candidates
  • Footnote 4 was added to all bortezomib-containing regimens stating, “Subcutaneous bortezomib is the preferred method of administration.” (Also for AMYL-A 2 of 4)
  • Footnote 5 was added to all lenalidomide-containing regimens stating, “Patients with cardiac amyloidosis should be carefully monitored while on lenalidomide therapy.” (Also for AMYL-A 2 of 4)
• Systemic Light Chain Amyloidosis Therapy for Previously Treated Disease (AMYL-A 2 of 4):
  • Footnote 9 was added to daratumumab stating, “Includes both daratumumab for intravenous infusion and daratumumab and hyaluronidase-fihj for subcutaneous injection. Daratumumab and hyaluronidase-fihj for subcutaneous injection has different dosing and administration instructions compared to daratumumab for intravenous infusion.”
  • Footnote 10 was added to daratumumab stating, “Test for hepatitis B before starting daratumumab.”

NCCN has published updates to the NCCN Guidelines, the NCCN Compendium, and NCCN Imaging AUC™ for Waldenström Macroglobulinemia/Lymphoplasmacytic Lymphoma. These NCCN Guidelines are currently available as Version 1.2021.

• Initial Diagnostic Workup (WM/LPL-1):
  • Under list of diagnostic tests useful in certain circumstances the following were added:
    • HIV testing
    • Brain/spine MRI, if CNS symptoms
  • Symptoms related to “B symptoms” were added as an indication for treatment
• Primary Treatment (WM/LPL-2):
  • “Consider rituximab for maintenance therapy” was removed as an option for those achieving very good partial response.
• Waldenström Macroglobulinemia International Workshop Criteria (WM/LPL-A):
  • IPSS Waldenström Macroglobulinemia scoring system tables were added
• Primary Therapy for Waldenström Macroglobulinemia/Lymphoplasmacytic Lymphoma (WM/LPL-B 1 of 3):
  • Footnotes regarding rituximab use were revised to include the following:
    • An addition to footnote 3 was added stating, “Blood warmers should be used for apheresis if cryoprecipitate or cryoglobulin are present.” (Also for WM/LPL-B 2 of 3)
    • An addition to footnote 4 was added stating, “Test for hepatitis B before starting therapy with rituximab, ofatumumab, or carfilzomib.” (Also for WM/LPL-B 2 of 3)
  • Footnote 10 was added regarding rituximab use stating, “Rituximab and hyaluronidase human injection for subcutaneous administration may be substituted for rituximab after patients have received the first full dose of rituximab by intravenous infusion.” (Also for WM/LPL-B 2 of 3)
• Therapy for Previously Treated Waldenström Macroglobulinemia/Lymphoplasmacytic Lymphoma (WM/LPL-B 2 of 3):
  • Ibrutinib ± rituximab was changed from a category 2A to a category 1 recommendation.
  • Everolimus was moved from “Other Recommended Regimens” to “Useful in Certain Circumstances”
  • Acalabrutinib was added as a new regimen to “Other Recommended Regimens”
  • Footnote 15 regarding ofatumumab use was revised stating, “…anywhere that rituximab is given.”

NCCN has published updates to the NCCN Chemotherapy Order Templates (NCCN Templates^®) for Squamous Cell Skin Cancer to reflect the currently published NCCN Guidelines for Squamous Cell Skin Cancer v2.2020.

• The following NEW NCCN Template has been published
  • SCC6: Pembrolizumab

NCCN has updated the NCCN Imaging AUC™ to reflect recommendations within the following NCCN Guidelines:

• Soft Tissue Sarcoma, Version 1.2020
• B-Cell Lymphomas, Version 1.2020

NCCN has published updates to the following NCCN Guidelines with NCCN Evidence Blocks™:

• B-Cell Lymphomas, Version 4.2020
• Chronic Myeloid Leukemia, Version 2.2021

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.

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