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NCCN Flash Updates: 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 Esophageal and Esophagogastric Junction Cancers. These NCCN Guidelines^® are currently available as Version 5.2020.

• Squamous Cell Carcinoma
  • Surgical outcomes/clinical pathologic findings for patients have received preoperative chemoradiation (ESOPH-7)
    • After "R0 resection" the pathway was revised to include a bifurcation for "yp T0, N0" and "yp T positive and/or N positive" patients as noted below. Previously, R0 resection, yp any T, any N were all recommended for surveillance.
      • Postoperative Management
        • For yp T0, N0, Surveillance is recommended.
        • For yp T positive and/or N positive, Nivolumab (category 1) is recommended.
• Adenocarcinoma
  • Surgical outcomes/clinical pathologic findings for patients have received preoperative Chemoradiation or Chemotherapy (ESOPH-16)
    • After "R0 resection" the pathway was revised as follows
      • Node negative (yp Any T) yp T0, N0
      • Node positive (yp Any T) yp T positive and/or N positive
        • For yp T positive and/or N positive patients, Nivolumab if received preoperative chemoradiation (category 1) was added as an option.
• Principles of Systemic Therapy (ESOPH-F)
  • Third bullet revised, Trastuzumab should be added to first-line chemotherapy for HER2 overexpression metastatic positive adenocarcinoma.
  • Perioperative Chemotherapy, Preferred Regimens: Fluorouracil, leucovorin, oxaliplatin, and docetaxel (FLOT) (category 1) moved to the top of the list of options.
  • Table heading: Postoperative Chemotherapy revised to Postoperative Therapy
    • Preferred Regimens
      • Nivolumab only after preoperative chemoradiation with R0 resection and residual disease (category 1) was added with corresponding footnote e See NCCN Guidelines for Management of Immunotherapy-Related Toxicities.
      • Other Recommended Regimens: "Capecitabine and oxaliplatin" and "Fluorouracil and oxaliplatin" were added. Previously they were listed as preferred options.
  • Systemic Therapy for Unresectable Locally Advanced, Recurrent or Metastatic Disease
    • First-Line Therapy
      • This page was extensively revised including:
        • The Preferred Regimens were revised to include new subheadings for HER2 overexpression positive adenocarcinoma and HER2 overexpression negative.
        • Under HER2 overexpression negative, the following new regimens were added
          • Fluoropyrimidine (fluorouracil or capecitabine), oxaliplatin, and nivolumab (PDL1 CPS ≥ 5) for adenocarcinoma only (category 1)
          • Fluoropyrimidine (fluorouracil or capecitabine), oxaliplatin, and pembrolizumab (PDL1 CPS ≥ 10)
          • Fluoropyrimidine (fluorouracil or capecitabine), cisplatin, and pembrolizumab (PDL1 CPS ≥ 10) (category 1)
        • Other Recommended Regimens heading changed to Other Recommended Regimens (trastuzumab should be added to first-line chemotherapy for HER2 overexpression positive adenocarcinoma)
          • The term “DCF modifications” was removed.
          • ECF (epirubicin, cisplatin, and fluorouracil) (category 2B) was removed as an option.
          • ECF modifications (category 2B) and the noted regimens below were removed as options
            • Epirubicin, oxaliplatin, and fluorouracil
            • Epirubicin, cisplatin, and capecitabine
            • Epirubicin, oxaliplatin, and capecitabine
      • Footnote e was added: See NCCN Guidelines for Management of Immunotherapy-Related Toxicities
      • Footnote g is new: See Principles of Pathologic Review and Biomarker Testing (ESOPH-B)
      • Footnote h was revised and added: If no previous treatment prior tumor progression while on therapy with a checkpoint inhibitor.
  • Principles of Systemic Therapy-Regimens and Dosing Schedules
    • The dosing schedules were updated to reflect the changes in the algorithm

NCCN has published updates to the NCCN Chemotherapy Order Template (NCCN Templates^®) for Esophageal and Esophagogastric Junction Cancers to reflect the NCCN Guidelines for Esophageal and Esophagogastric Junction Cancers v5.2020.

• The following NCCN Templates^® have been removed:
  • ESO1: ECF (EpiRUBicin/CISplatin/Fluorouracil)
  • ESO2: ECX (EpiRUBicin/CISplatin/Capecitabine)
  • ESO3: EOF (EpiRUBicin/OXALIplatin/Fluorouracil)
  • ESO4: EOX (EpiRUBicin/OXALIplatin/Capecitabine)

NCCN has published updates to the NCCN Guidelines and the NCCN Compendium^® for Gastric Cancer. These NCCN Guidelines are currently available as Version 4.2020.

• Principles of Pathologic Review and Biomarker Testing
  • GAST-B 2 of 6 Assessment of Treatment Response
    • Table 2; Number of lymph nodes retrieved: Bullet revised, While there is no universally accepted minimum number of lymph nodes necessary for accurate staging of gastric cancer, retrieval of at least 15 lymph nodes is recommended to avoid stage migration. Although it is suggested that at least 16 regional lymph nodes be pathologically assessed, removal and assessment of over 30 lymph nodes is desirable.
• Principles of Systemic Therapy (GAST-F)
  • Third bullet revised, Trastuzumab should be added to first-line chemotherapy for HER2 overexpression metastatic positive adenocarcinoma.
  • Perioperative Chemotherapy, Preferred Regimens: Fluorouracil, leucovorin, oxaliplatin, and docetaxel (FLOT) (category 1) moved to the top of the list of options.
  • Systemic Therapy for Unresectable Locally Advanced, Recurrent, or Metastatic Disease (where local therapy is not indicated)
    • First-Line Therapy
      • This page was extensively revised including:
        • Preferred Regimens was revised to include new subheadings for HER2 overexpression positive adenocarcinoma and HER2 overexpression negative.
        • Under HER2 overexpression negative, the following new regimen was added
          • Fluoropyrimidine (fluorouracil or capecitabine), oxaliplatin, and nivolumab (PDL1 CPS ≥ 5) (category 1)
        • Other Recommended Regimens heading changed to Other Recommended Regimens (trastuzumab should be added to first-line chemotherapy for HER2 overexpression positive adenocarcinoma)
          • The term “DCF modifications” was removed.
          • ECF (epirubicin, cisplatin, and fluorouracil) (category 2B) was removed as an option
          • ECF modifications (category 2B) and the noted regimens below were removed as options
            • Epirubicin, oxaliplatin, and fluorouracil
            • Epirubicin, cisplatin, and capecitabine
            • Epirubicin, oxaliplatin, and capecitabine
      • Footnote f is new: See Principles of Pathologic Review and Biomarker Testing (GAST-B)
      • Footnote g was revised and added: If no previous treatment prior tumor progression while on therapy with a checkpoint inhibitor.
      • Footnote h was added: See NCCN Guidelines for Management of Immunotherapy-Related Toxicities
  • Principles of Systemic Therapy-Regimens and Dosing Schedules
    • The dosing schedules were updated to reflect the changes in the algorithm.

NCCN has published updates to the NCCN Templates for Gastric Cancer to reflect the NCCN Guidelines for Gastric Cancer v4.2020.

• The following NCCN Templates have been removed:
  • GAS1: ECF (EpiRUBicin/CISplatin/Fluorouracil)
  • GAS2: ECX (EpiRUBicin/CISplatin/Capecitabine)
  • GAS3: EOF (EpiRUBicin/OXALIplatin/Fluorouracil)
  • GAS4: EOX (EpiRUBicin/OXALIplatin/Capecitabine)

NCCN has updated the NCCN Imaging Appropriate Use Criteria (NCCN Imaging AUC™) to reflect recommendations within the following NCCN Guidelines:

• Melanoma: Cutaneous, Version 1.2021

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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