NCCN Flash Updates: NCCN Guidelines®, NCCN Compendium® Updated for Bladder Cancer and More
NCCN has published updates to the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®), the NCCN Drugs & Biologics Compendium (NCCN Compendium®), the NCCN Radiation Therapy Compendium™, and the NCCN Imaging Appropriate Use Criteria (NCCN Imaging AUC™) for Bladder Cancer. These NCCN Guidelines® are currently available as Version 1.2021.
Link to the NCCN Guidelines:
NCCN Guidelines for Bladder Cancer
- Bladder Cancer
- Initial evaluation, 2nd bullet was revised, "Office cystoscopy, enhanced if available.” (BL-1)
- Non-muscle invasive bladder cancer, the algorithms were extensively revised to provide recommendations for management based on AUA risk stratification group. (BL-2 and BL-3)
- Management of Positive Urine Cytology (BL-4)
- Evaluation
- 1st bullet was added, "If initial positive cytology, consider repeating cytology test within 3 months."
- 2nd bullet was added, "If repeated positive cytology," and the current recommendations were added as sub-bullets to this bullet.
- Stage II (cT2, N0) Primary and Adjuvant Treatment (BL-5)
- Additional Workup
- Last bullet was added: "Estimate GFR to assess eligibility for cisplatin" with footnote v: "For patients with borderline GFR consider timed urine collection, which may more accurately determine eligibility for cisplatin." Also for BL-7, BL-8, and BL-9.
- Adjuvant Treatment of Cystectomy candidates was updated. Also for BL-7.
- "Based on pathologic risk, consider
- Adjuvant cisplatin-based chemotherapy if no neoadjuvant treatment, or
- Adjuvant RT (pT3–4, or positive nodes/margins or positive margins) (category 2B)
- Stage II (cT2, N0) Non-Cystectomy Candidates (BL-6)
- Adjuvant treatment, tumor pathway: "± intravesical therapy" was added to TURBT. Also for BL-7.
- Stage IVA (cT4b, Any N, M0; Any T, Any N, M1a) Primary and Subsequent Treatment (BL-9)
- M1a disease, subsequent treatment, the complete response option was revised from "Concurrent chemoradiotherapy or Cystectomy" to "Consider consolidative local therapy in selected cases."
- Principles of Imaging for Bladder/Urothelial Cancer
- Urothelial Carcinoma of the Prostate/Primary Carcinoma of the Urethra, Staging, 1st bullet was revised: Staging: Chest CT (preferred) or PA and lateral chest x-ray or chest CT. (BL-A 4 of 5)
- Bladder Cancer: Non-Urothelial and Urothelial with Variant Histology (BL-D 1 of 2)
- Any Small-Cell Component (or neuroendocrine features), 1st bullet: "(See systemic therapy in NCCN Guidelines for Small Cell Lung Cancer)" was added.
- Follow-up
- Table 8 for metastatic disease that is being observed was added. (BL-E 6 of 6)
- Principles of Intravesical Treatment
- Intrapelvic and Intravesical Therapy for Upper Tract Tumors (BL-F 2 of 3)
- Postsurgical therapy, bullet was revised: Perioperative intravesical chemotherapy with mitomycin or gemcitabine may be given should be considered following nephroureterectomy with cuff of bladder resection.
- Principles of Systemic Therapy
- Table header was clarified: Perioperative chemotherapy (neoadjuvant [preferred for bladder] or adjuvant) (BL-G 1 of 7)
- 8th bullet, sub-bullet was added: Adjuvant therapy should be considered if neoadjuvant was not given for UTUC (Birtle A, et al. Lancet 2020;395:1268-1277).
- First-line systemic therapy for locally advanced or metastatic disease (Stage IV)
- Avelumab maintenance was clarified as a category 1 recommendation. (BL-G 2 of 7)
- Second-line systemic therapy for locally advanced or metastatic disease (Stage IV) (post-platinum) (BL-G 3 of 7)
- Alternative preferred regimens, durvalumab was removed as an option based on the FDA withdrawal of the indication.
- Footnote e was added: Also for patients who received a therapy other than platinum or an immune checkpoint inhibitor in first-line.
- Subsequent-line systemic therapy for locally advanced or metastatic disease (Stage IV) (BL-G 4 of 7)
- Preferred regimens, enfortumab vedotin was changed from a category 2A to a category 1 recommendation and corresponding reference was added: Powles T, Rosenberg JE, Sonpavde G, et al. Enfortumab vedotin in previously treated advanced urothelial carcinoma. N Engl J Med 2021. Online ahead of print.
- Footnote h was added: These therapies are appropriate for patients who received a first-line platinum-containing chemotherapy followed by avelumab maintenance therapy.
- Principles of Radiation Management of Invasive Disease (BL-H)
- 10th bullet was revised: Concurrent chemoradiotherapy (preferred) or RT alone should be considered as potentially curative therapy for medically inoperable patients. Concurrent chemoradiotherapy or RT alone should be considered for local palliation in patients with metastatic disease.
- 14th bullet was revised by removing the follow-up recommendations and directing to Table 7 on BL-E.
- Upper GU Tract Tumors
- Workup: "or CT" was added to Chest x-ray. (UTT-1) Also for UTT-2, UCP-1 and PCU-1.
- Adjuvant therapy for pT2, pT3, pT4, pN+, "± RT" was added to "Consider adjuvant chemotherapy." (UTT-3)
- Primary Carcinoma of the Urethra
- cN0, Primary treatment, last option was revised, "Consolidative Surgery alone for non-urothelial histology." (PCU-3)
NCCN has published updates to the NCCN Chemotherapy Order Templates (NCCN Templates®) for Bladder Cancer to reflect the currently published NCCN Guidelines for Bladder Cancer v1.2021.
- The following NCCN Template® has been DELETED:
NCCN has published updates to the NCCN Templates for Systemic Light Chain Amyloidosis to reflect the currently published NCCN Guidelines for Systemic Light Chain Amyloidosis v2.2021.
- The following NEW NCCN Template has been published:
- SLCA19: Bortezomib/Cyclophosphamide/Dexamethasone + Daratumumab and Hyaluronidase-fihj
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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