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^®) for Ovarian Cancer. These NCCN Guidelines^® are currently available as Version 2.2020.

• Select pages in the Discussion section have been updated to reflect the changes in the algorithm. (MS-1 to MS-82)

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

NCCN has published updates to the NCCN Guidelines and the NCCN Drugs and Biologics Compendium (NCCN Compendium^®) for Chronic Myeloid Leukemia (CML). These NCCN Guidelines are currently available as Version 3.2021.

• Primary Treatment of chronic phase CML (CML-3)
  • Footnote g modified: Based on preliminary data from the BFORE trial and long-term follow-up data from the BFORE, DASISION and ENESTnd trials, second-generation TKIs (bosutinib, dasatinib, or nilotinib) are preferred for patients with an intermediate- or high-risk score, especially for young women whose goal is to achieve a deep and rapid molecular response and eventual drug discontinuation of TKI therapy for family planning purposes.
• Treatment Recommendations Based on BCR-ABL1 Mutational Profile (CML-5)
  • Footnote w modified: Ponatinib is a treatment option for patients with a T315I mutation and/or for patients for whom no other TKI is indicated. Ponatinib is a treatment option for patients with a T315I mutation and/or CP-CML with resistance or intolerance to at least 2 prior TKIs or for patients with AP-CML or BP-CML for whom no other TKI is indicated.
• Management of Bosutinib Toxicity (CML-G 1 of 8)
  • Dosing added
    • Newly diagnosed CP-CML: The recommended initial dose is 400 mg once daily.
    • CP-CML, AP-CML or BP-CML with resistance or intolerance to prior therapy: The recommended initial dose is 500 mg once daily.
• Management of Dasatinib Toxicity (CML-G 2 of 8)
  • Dosing added
    • CP-CML: The recommended initial dose is 100 mg once daily.
    • AP-CML and BP-CML: The recommended initial dose is 140 mg once daily.
• Management of Imatinib Toxicity (CML-G 3 of 8)
  • Dosing added
    • CP-CML: The recommended initial dose is 400 mg once daily.
    • AP-CML and BP-CML: The recommended initial dose is 600 mg once daily.
• Management of Nilotinib Toxicity (CML-G 4 of 8)
  • Dosing added
    • Newly diagnosed CP-CML: The recommended initial dose is 300 mg twice daily.
    • Resistant or intolerant CP-CML and AP-CML: The recommended initial dose 400 mg twice daily.
    • BP-CML: The recommended initial dose 400 mg twice daily.
• Management of Omacetaxine Toxicity (CML-G 5 of 8)
  • Dosing added
    • Induction Dose: The recommended initial dose is 1.25 mg/m² twice daily for 14 consecutive days of a 28-day cycle.
    • Maintenance Dose: 1.25 mg/m² twice daily for 7 consecutive days of a 28-day cycle.
• Management of Ponatinib Toxicity (CML G 6 of 8)
  • Dosing section modified
    • The recommended initial dose of ponatinib is 45 mg once daily. However, an initial starting dose of 30 mg may be a safer and effective dose for patients with risk factors. Safety and efficacy of ponatinib at initial doses lower than 45 mg is being evaluated in a randomized clinical trial.
    • CP-CML: The recommended initial dose is 45 mg once daily with a reduction to 15 mg once daily upon achievement of BCR-ABL1 (IS) ≤1%. In patients with a loss of response, the dose can be re-escalated to a previously tolerated dose of 30 mg or 45 mg once daily and continue at the re-escalated dose until loss of response or unacceptable toxicity.
    • AP-CML or BP-CML: The recommended initial dose is 45 mg once daily. Consider reducing the dose for patients with AP-CML who have achieved a MCyR. Consider discontinuing ponatinib if response has not occurred by 3 months.
• Discussion section updated to reflect the changes in the algorithm (MS-1).

NCCN has published updates to the NCCN Chemotherapy Order Templates (NCCN Templates^®) for Blastic Plasmacytoid Dendritic Cell Neoplasm (BPDCN) to reflect the currently published NCCN Guidelines for Acute Myeloid Leukemia (AML) v2.2021.

• Changes to the Indication section have been made to the following templates:
  • BPDCN7: Venetoclax/Decitabine
  • BPDCN8: Venetoclax/AzaCITIDine
  • BPDCN9: Venetoclax/Low-Dose Cytarabine
• Febrile Neutropenia Risk has been updated on the following templates:
  • BPDCN4a: HyperCVAD (Cyclophosphamide/VinCRIStine/DOXOrubicin/Dexamethasone) (Cycle A) alternating with High-Dose Methotrexate/Cytarabine (Cycle B) - HyperCVAD (Cycle A) Course
  • BPDCN4b: HyperCVAD (Cyclophosphamide/VinCRIStine/DOXOrubicin/Dexamethasone) (Cycle A) alternating with High-Dose Methotrexate/Cytarabine (Cycle B) - High-Dose Methotrexate/Cytarabine (Cycle B) Course
  • BPDCN5: CHOP (Cyclophosphamide/DOXOrubicin/VinCRIStine/PredniSONE)
• The following infection note has been updated in the Other Supportive Therapy section:
  • Risk of serious bacterial, viral, and fungal infections exists during treatment. Refer to drug package insert, individual NCCN disease guideline, and NCCN Guidelines for Prevention and Treatment of Cancer-Related Infections for monitoring, prophylaxis, and/or preemptive therapy recommendations.
• Update to notes for central venous access were made in the Safety Parameters and Special Instructions section of the following template:
  • BPDCN4a: HyperCVAD (Cyclophosphamide/VinCRIStine/DOXOrubicin/Dexamethasone) (Cycle A) alternating with High-Dose Methotrexate/Cytarabine (Cycle B) - HyperCVAD (Cycle A) Course
• Drug information notes for the following agents have been updated in the Supportive Care, Monitoring and Hold Parameters, and/or Safety Parameters and Special Instructions sections:
  • AzaCITIDine
  • Decitabine
  • Dexamethasone
  • IDArubicin
  • Tagraxofusp-erzs

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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