NCCN Flash Updates: NCCN Guidelines Updated
NCCN has published updates to the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Kidney Cancer. These NCCN Guidelines® are currently available as Version 3.2022.
Link directly to the Updates section of the NCCN Guidelines:
Kidney Cancer
- The Discussion section has been updated to reflect the changes in the algorithm. (MS-1)
Previous updates to the NCCN Guidelines for Kidney Cancer can be found in the UPDATES section of the current version.
NCCN has published updates to the NCCN Guidelines the NCCN Radiation Therapy Compendium™, the NCCN Imaging Appropriate Use Criteria (NCCN Imaging AUC™), and the NCCN Drugs and Biologics Compendium (NCCN Compendium®) for Uterine Neoplasms, These NCCN Guidelines are currently available as Version 1.2022.
Link directly to the Updates section of the NCCN Guidelines:
Uterine Neoplasms
- General
- Separate pathways were created for the following high-risk endometrial carcinoma histologies: Serous carcinoma (ENDO-11), Clear cell carcinoma (ENDO-12), or Undifferentiated/dedifferentiated carcinoma (ENDO-13) and Carcinosarcoma (ENDO-14). Previously these histologies were on the same page and treated similarly.
- The Uterine Sarcoma algorithms were extensively revised to include recommendations and new pathways for the treatment of adenosarcoma ± sarcomatous overgrowth (SO). (UN-1, UTSARC-1 through UTSARC-6)
- The AJCC Staging tables were updated to include staging for adenosarcoma (ST-4)
- Uterine Neoplasms
- Initial evaluation and Clinical Findings (UN-1)
- 5th bullet revised: Consider genetic evaluation Recommend genetic evaluation of tumor and evaluation for inherited cancer risk.
- Under "Malignant mesenchymal (sarcoma)" first bullet revised: Low-grade endometrial stromal sarcoma (ESS) or adenosarcoma
- New pathway was added for “High-risk endometrial carcinoma histology”.
- Endometrial Carcinoma
- Disease limited to the uterus (ENDO-1)
- Not suitable for primary surgery; Primary Treatment: Revised, Consider hormone therapy (including progestin IUD) in select patients.
- Surgically staged: Stage I (ENDO-4)
- Adjuvant Treatment
- FIGO Stage IA; G3: Consider EBRT if high-intermediate risk (HIR) either age ≥70 y or LVSI (category 2B)
- FIGO Stage IB; G1: Consider observation if age <60 y and no LVSI other adverse risk factors
- FIGO Stage IB, G2:
- Consider EBRT if HIR ≥60 y and/or LVSI
- Consider observation if age <60 y and no LVSI no other adverse risk factors
- Criteria for Fertility-Sparing Options For Management of Endometrial Carcinoma (ENDO-8)
- Second column; 2nd bullet revised: Genetic counseling/testing in selected patients Recommend genetic evaluation of tumor and evaluation for inherited cancer risk (See UN-1)
- Primary treatment; 1st bullet; 3rd arrow sub-bullet revised: Levonorgestrel Progestin IUD
- Surveillance
- Complete response by 6 mo pathway: New recommendation added, Ovarian preservation may be considered in select premenopausal patients.
- Endometrial cancer present at 6–12 mo pathway: New recommendation added, Ovarian preservation may be considered in select patients.
- Principles of Pathology and Molecular Analysis (ENDO-A)
- Pathologic assessment for carcinoma
- 6th bullet revised: "...recommended for possible treatment of advanced-stage or recurrent serous endometrial carcinoma or carcinosarcoma."
- New bullet added: Consider HER2 IHC testing in TP53-aberrant endometrial carcinoma regardless of histotyping.
- Principles of Molecular Analysis
- New bullet added: Consider comprehensive genomic profiling via a validated and/or FDA-approved assay in the initial evaluation of uterine neoplasms.
- Fourth bullet revised: Universal testing of endometrial carcinomas for MMR proteins/MSI is recommended (MSI testing if results equivocal).
- 2nd arrow sub-bullet revised: "...promoter methylation to assess an epigenetic process mechanism.
- Principles of Imaging (ENDO-B)
- Initial Workup; Non–Fertility-Sparing Treatment
- 4th arrow sub-bullet revised: For high-grade carcinoma, consider chest/abdomen/pelvis CT (preferred) to evaluate for metastatic disease.
- 5th arrow sub-bullet revised: For patients who underwent TH with incidental finding of endometrial cancer or whose cancer was incompletely staged..."
- Principles of Evaluation and Surgical Staging (ENDO-C Page 1 of 6)
- 7th bullet revised: SLN mapping may be considered is preferred.
- Last bullet revised: For stage II patients, TH/BSO is the standard procedure. extrafascial or radical hysterectomy should be based on preoperative workup with the goal of achieving negative margins. Radical hysterectomy should only be performed if needed to obtain negative margins.
- Principles of Evaluation and Surgical Staging When SLN Mapping is Used (ENDO-C)
- New bullet added: SLN identification should always be done prior to hysterectomy, except in cases where a bulky uterus must be removed to allow access to iliac vessels and LNs.
- Systemic Therapy for Endometrial Carcinoma (ENDO-D)
- Systemic Therapy Table
- Titles revised
- Primary or Adjuvant Treatment When Used for Uterine-Confined High-Risk Disease
- Recurrent, or Metastatic, Or High-Risk Disease
- Biomarker-directed systemic therapy for second-line treatment; Preferred regimens: Clarified as, Lenvatinib/pembrolizumab (category 1) for non–MSI-high [MSI-H]/non-MMR-deficient [dMMR] tumors
- Footnote l revised: "...as determined by an a validated and/or FDA-approved test,..."
- Hormone Therapy Table Title revised: Recurrent, Metastatic, or High-Risk Disease Hormone Therapy.
- Uterine Sarcoma
- Additional Evaluation (UTSARC-1)
- Last bullet revised for both pathways: Consider ER/PR testing for LMS, ESS, and adenosarcoma
- After "Tumor initially fragmented or Residual cervix," revised: Consider re-exploration/reresection.
- Last column revised to: High-grade ESS or UUS or uLMS or Other sarcomas
- Additional therapy for High-grad ESS, UUS, uLMS (UTSARC-4)
- Stage II, III: Consider observation if completely resected with negative margins added as an option.
- Footnote removed: Observation may be an option in select, completely resected cases with no evidence of disease on postoperative imaging.
- Surveillance (UTSARC-5)
- 2nd bullet revised: Imaging as clinically indicated
- Therapy for Relapse (UTSARC-6)
- Footnote m revised: “For low-grade ESS or adenosarcoma without SO, the first choice of systemic therapy…”
- Principles of Pathology and Molecular Analysis (UTSARC-A)
- Table 1 (Uterine Sarcoma Classifications) was extensively revised.
- Systemic Therapy for Uterine Sarcoma (UTSARC-C)
- Systemic Therapy for Uterine Sarcoma (UTSARC-C)Systemic Therapy for Uterine Sarcoma (UTSARC-C)
- Systemic therapies; Preferred regimens: Docetaxel/gemcitabine moved from Other Recommended Regimens to the list of Preferred Regimens.
- Biomarker-Directed Systemic Therapy for Second-Line Treatment; Useful in Certain Circumstances: Consider PARP inhibitors for BRCA2- altered uLMs was listed as an option. The following PARP inhibitors were listed:
- Olaparib
- Rucaparib
- Niraparib
- Hormone Therapy Table;
- First column header revised: Anti-Estrogen Hormone Therapy for Low-Grade ESS or Adenosarcoma Without SO or Hormone Receptor-Positive (ER/PR) uLMS Uterine Sarcomas
- Preferred regimens: Aromatase inhibitors for low-grade ESS or adenosarcoma without SO
- Other recommended regimens; The following changes were made:
- Aromatase inhibitors (for ER/PR-positive uLMS uterine sarcomas)
- Megestrol acetate (category 2B for ER/PR-positive uLMS uterine sarcomas
- Medroxyprogesterone acetate (category 2B for ER/PR-positive uLMS uterine sarcomas)
- GnRH analogs (category 2B for low-grade ESS, adenosarcoma without SO, and ER/PR-positive uLMS uterine sarcomas)
- Footnote e revised: "These hormonal therapies may be considered for patients with uLMS uterine sarcomas that are ER/PR-positive..."
- Uterine Neoplasms
- Principles of Radiation Therapy for Uterine Neoplasms (UN-A)
- General Principles–Uterine Neoplasms: New bullet added, Chemoradiation can be given concurrently or sequentially
- Principles of Gynecologic Survivorship (UN-B)
- Psychosocial effects revised: Psychosocial effects after cancer may include be psychological (eg, depression, anxiety, fear of recurrence, altered body image), financial (eg, return to work, insurance concerns), and/or interpersonal (eg, relationships, sexuality, intimacy) effects in nature.
- Clinical approach
- 1st bullet: "...focuses on managing chronic disease management, monitoring of cardiovascular risk factors, providing recommended vaccinations..."
- 2nd bullet: "...physical examination, and conduct provide any necessary imaging and/or laboratory testing. All women patients, whether sexually active or not, should be asked about genitourinary symptoms, including vulvovaginal dryness..."
- New bullet added: For premenopausal patients, hormone replacement therapy should be considered
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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