NCCN Flash Updates: NCCN Guidelines® and NCCN Compendium® Updated for Vulvar Cancer and More
NCCN has published updates to the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) and the NCCN Drugs & Biologics Compendium (NCCN Compendium®) for Gestational Trophoblastic Neoplasia. These NCCN Guidelines® are currently available as Version 3.2020.
- Principles of Systemic Therapy (GTN-B)
- High-Risk GTN: Therapy for Methotrexate-Resistant GTN (GTN-B 5 of 6) and Intermediate Trophoblastic Tumor (PSTT and ETT) (GTN-B 6 of 6)
- Useful in Certain Circumstances:
- Additional agents/regimens shown to have some activity in treating multiagent chemotherapy-resistant GTN: Avelumab 800 mg IV every 2 weeks was added to the list of PD-1/PD-L1 inhibitors.
Previous updates to the NCCN Guidelines for Gestational Trophoblastic Neoplasia 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 Vulvar Cancer. These NCCN Guidelines are currently available as Version 1.2021.
- General
- Principles of Gynecologic Survivorship: This is a new section that discusses the physical and psychosocial effects of gynecologic cancers as well as clinical approaches to managing them. (VULVA-F)
- Workup (VULVA-1)
- Eighth bullet revised: Consider cervical HPV and cytology testing.
- Principles of Pathology (VULVA-A)
- General Principles; First bullet revised: "... HPV-associated SCC frequently occurs in younger women, is frequently multifocal, is associated with classic VIN, and can be seen in association with additional sites of lower genital tract squamous neoplasia. and is p16 positive and p53 negative by immunohistochemistry (IHC). Immunohistochemistry (IHC) shows strong, diffuse, block-like positive nuclear and cytoplasmic staining with p16 and wild-type p53 (heterogeneous staining pattern). Non–HPV-associated SCC usually occurs in older women, is unifocal, and is associated with differentiated vulvar intraepithelial neoplasia (dVIN), may be p53 positive, and is usually p16 negative or focally positive by IHC. IHC shows aberrant p53 staining (widespread, strong nuclear expression or complete absence/null expression) and patchy (negative) p16 staining. A meta-analysis...".
- Principles of Imaging (VULVA-B)
- Whole-body PET/CT changed to Neck/chest/abdomen/pelvis/groin PET/CT throughout section.
- Systemic Therapy Regimens for Vulvar Cancer (VULVA-E)
- General: The tables for Chemoradiation and Advanced or Recurrent/Metastatic Disease were reformatted.
- Chemoradiation; Other Recommended Regimens: Cisplatin/fluorouracil moved above Fluorouracil/mitomycin C on the list.
- Chemotherapy for Advanced, Recurrent/Metastatic Disease
- A new section was added for Biomarker-directed systemic therapy for second-line treatment.
- Biomarker-directed systemic therapy for second-line treatment.
- Revised: Pembrolizumab (second-line therapy for TMB-H, PD-L1–positive, or MSI-high [MSI-H]/MMR deficient [dMMR] or TMB-H tumors)
- Nivolumab was added as an option with corresponding footnote "e" For mismatch repair-deficient (dMMR) advanced or recurrent/metastatic vulvar cancer.
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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