eBulletin Newsletter

NCCN Flash Updates: NCCN Guidelines and NCCN Templates Updated

NCCN has published updates to the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®), the NCCN Drugs and Biologics Compendium (NCCN Compendium), the NCCN Radiation Therapy Compendium™, and the NCCN Imaging Appropriate Use Criteria (NCCN Imaging AUC™) for Breast Cancer. These NCCN Guidelines® are currently available as Version 1.2022.

Link directly to the Updates section of the NCCN Guidelines:
Breast Cancer

  • Workup (BINV-1)
    • Pathology review, sub-bullet added: Ki-67 test if considering adjuvant abemaciclib (see BINV-K).
    • Fifth bullet modified: Genetic counseling and testing if patient is at risk for hereditary breast cancer, has triple-negative breast cancer (TNBC) (at any age), or is a candidate for adjuvant olaparib.
  • Systemic Adjuvant Treatment
    • Footnote ee modified: Consider adjuvant bisphosphonate therapy for risk reduction of distant metastasis for 3–5 years in postmenopausal patients with (natural or induced) menopause with high-risk node-negative or node-positive tumors. (BINV-5 through BINV-11 and BINV-16)
    • Footnote jj added: Addition of 1 year of adjuvant olaparib is an option for select patients with germline BRCA1/2 mutation after completion of adjuvant chemotherapy. See BINV-L (1 of 8). (BINV-6, BINV-8 and BINV-10)
  • Workup Prior to Preoperative Systemic Therapy (BINV-12)
    • Clinical stage, criteria modified: c≥T2 or cN+ and M0 or cT1,N0 HER2-positive disease or cT1,N0 TNBC and Considering preoperative systemic therapy (For preoperative systemic therapy criteria, see BINV-M, 1 of 2)
  • Operable Disease (BINV-14)
    • Adjuvant therapy after breast-conserving surgery, last bullet added: Any cN0, ypN0: Adjuvant RT to whole breast ± boost to tumor bed
    • Adjuvant therapy after mastectomy, last option added: or Adjuvant systemic therapy (see BINV-16) without adjuvant RT for any cN0,ypN0 if axilla was assessed by SLNB or axillary node dissection.
  • Adjuvant Systemic Therapy After Preoperative Systemic Therapy (BINV-16)
    • HR-positive/HER2-Negative disease
      • ypT0N0 or pCR or ypT1–4,N0 or ypN≥1, adjuvant systemic therapy modified: Adjuvant endocrine therapy (category 1) + adjuvant olaparib if germline BRCA1/2 mutation CPS+EG score ≥3, and residual disease
    • HR-Negative/HER2-Negative disease
      • ypT0N0 or pCR, adjuvant systemic therapy added:
        • For high-risk: Adjuvant pembrolizumab (if pembrolizumab-containing regimen was given preoperatively)
      • ypT1–4,N0 or ypN≥1, adjuvant systemic therapy options modified: Consider Adjuvant capecitabine (6–8 cycles) or Adjuvant olaparib for 1 year if germline BRCA1/2 mutation or Adjuvant pembrolizumab (if pembrolizumab-containing regimen was given preoperatively)
    • Footnote zz added: High-risk criteria include stage II–III TNBC. The use of adjuvant pembrolizumab (category 2A) may be individualized.
    • Footnote aaa added: Patients in the OlympiA trial did not receive capecitabine; thus, there are no data on sequencing or to guide selection of an adjuvant therapy. 
  • Treatment of Local and Regional Recurrence
    • Footnote iii modified: In patients with a local breast recurrence after BCS who had a prior SLNB, a repeat SLNB may be considered although the accuracy of repeat SLNB is unproven. On the other hand, the prognostic significance of repeat SNB after mastectomy is unknown and its use is discouraged. After mastectomy, repeat SLNB may be considered although there are limited data in this setting.
  • Considerations for Surgical Axillary Staging (BINV-D)
    • Top pathway, sentinel lymph node mapping and excision, and sentinel lymph node positive
      • Added pathways for "breast-conserving surgery" versus "mastectomy." 
      • Added option for consideration of no further axillary surgery for those who meet all of the following criteria after mastectomy:
        • cT1–T2, cN0
        • No preoperative chemotherapy
        • 1–2 positive SLNs
        • Adjuvant RT planned with intentional inclusion of undissected axilla at risk
      • Footnote removed: For patients with clinically negative axilla who are undergoing mastectomy and for whom RT is planned, axillary radiation may replace axillary dissection level I/II for regional control of disease.
  • Principles of Breast Reconstruction Following Surgery (BINV-H, 5 of 7)
    • Second bullet added: Some patients may choose not to have reconstruction after mastectomy. The option to undergo mastectomy alone with a surgically optimized closure should be offered to all patients as part of a comprehensive discussion of reconstructive options. Achieving the optimal result in this scenario may require additional procedures beyond the initial mastectomy. See BINV-H (6 of 7) for patient factors influencing choice of reconstruction.
  • Principles of Radiation Therapy
    • Whole Breast Radiation (WBRT) (BINV-I, 1 of 3)
      • Bullet added: Ultra-hypofractionated WBRT of 28.5 Gy delivered as 5 (once-a-week) fractions may be considered in select patients aged >50 years following BCS with pTis/T1/T2/N0, though the optimal fractionation for the boost delivery is unknown for this regimen.
      • Footnote a added: Alternatively, 26 Gy in 5 daily fractions over one week may be considered, though data beyond 5 years for local relapse or toxicity are not yet available for this regimen. (Murray Brunt A, Haviland JS, Wheatley DA, et al. Hypofractionated breast radiotherapy for 1 week versus 3 weeks (FAST-Forward): 5-year efficacy and late normal tissue effects results from a multicentre, non-inferiority, randomised, phase 3 trial. Lancet 2020;395:1613-1626.)
    • RT with Preoperative or Adjuvant Systemic Therapy (BINV-I, 2 of 3)
      • Bullet and subsequent sub-bullets added on sequencing of RT with systemic therapy.
  • Adjuvant Endocrine Therapy (BINV-K)
    • Footnote d added: In patients with HR-positive/HER2-negative, high-risk breast cancer (ie, those with ≥4 positive lymph nodes, or 1–3 positive lymph nodes with one or more of the following: Grade 3 disease, tumor size ≥5 cm, or a Ki-67 score of ≥20%) 2 years of adjuvant abemaciclib can be considered. 
    • Footnote f added: Evidence suggests that the magnitude of benefit from surgical or radiation ovarian ablation in premenopausal patients with HR-positive breast cancer is similar to that achieved with CMF alone.
    • Line added to footnote i: Patients with lymph node involvement may benefit from extended aromatase inhibitor duration (7.5–10 years total).
  • Preoperative/Adjuvant Therapy Regimens
    • HER2-Negative Disease (BINV-L, 1 of 9)
      • Useful in Certain Circumstances, regimen added: Capecitabine (maintenance therapy for TNBC following adjuvant chemotherapy)
      • Dose/administration (BINV-L, 5 of 9)
        • Other recommended regimens
          • Weekly paclitaxel + carboplatin (preoperative setting only), modified: Carboplatin AUC 5 or 6 day 1
          • Added: Weekly paclitaxel + weekly carboplatin
            • Paclitaxel 80 mg/m2 days 1, 8, and 15
            • Carboplatin AUC 1.5–2 days 1, 8, and 15
            • Cycled every 28 days x 6 cycles
        • Useful in Certain Circumstances
          • CMF chemotherapy, added "IV acceptable" beside cyclophosphamide.
          • Added: Capecitabine; 650 mg/m2 PO twice daily on days 1–28; Cycled every 28 days for 1 year
    • HER2-Positive disease (BINV-L)
      • Useful in Certain Circumstances, the following options were added (page 2 of 9) along with dosing (page 8 of 9):
        • Neratinib (adjuvant setting only)
        • Paclitaxel + trastuzumab + pertuzumab
        • Ado-trastuzumab emtansine (TDM-1) (adjuvant setting only)
    • New page added: Additional Considerations for Those Receiving Preoperative/Adjuvant Therapy (BINV-L, 3 of 9)
  • Gene Expression Assays For Consideration Of Adjuvant Systemic Therapy (BINV-N)
    • Treatment Implications updated for 70-gene (MammaPrint) (for pN0 and 1–3 positive nodes).
  • Definition of Menopause (BINV-O)
    • This page has been significantly revised.
  • Systemic Therapy For ER- and/or PR-Positive Recurrent Unresectable (Local Or Regional) Or Stage IV (M1) Disease (BINV-P) 
    • HER2-Negative and Postmenopausal or Premenopausal Receiving Ovarian Ablation or Suppression
      • All single agents that were previously listed under "Preferred Regimens" have been changed to "Other Recommended regimens: First- and Subsequent-Line Therapy."
      • Other recommended regimens for first- and subsequent-line therapy:
        • Fulvestrant was changed from a category 1 to a category 2A option.  
        • Option removed: Toremifene
    • Footnote b added: In phase 3 randomized controlled trials, ribociclib + endocrine therapy has shown overall survival benefit in the first-line setting.
    • Footnote d added: In phase 3 randomized controlled trials, fulvestrant in combination with a CDK4/6 inhibitor (abemaciclib, palbociclib, and ribociclib) has shown overall survival benefit in the second-line setting.
  • Systemic Therapy Regimens for Recurrent Unresectable (Local Or Regional) OR Stage IV (M1) Disease
    • HER2-negative disease (BINV-Q, 1 of 8)
      • Useful in certain circumstances, option removed: paclitaxel/bevacizumab
    • HER2-positive disease (BINV-Q, 2 of 8)
      • Second-line option added: Fam-trastuzumab deruxtecan-nxki; this is a category 1, preferred regimen.
      • Second-line option modified: Ado-trastuzumab emtansine (TDM-1) has been changed from a category 1, preferred regimen to a category 2A, other recommended regimen.
      • Heading modified: Third line and beyond (optimal sequence is not known)
      • Footnote j modified: Regimens may also be used as an option for third-line and beyond or fourth-line option; the optimal sequence for third-line therapy and beyond is not known.
      • Footnote l added: Fam-trastuzumab deruxtecan-nxki may be considered in the first-line setting as an option for select patients (ie, those with rapid progression within 6 months of neoadjuvant or adjuvant therapy [12 months for pertuzumab-containing regimens]).
      • Footnote n modified: Tucatinib + trastuzumab + capecitabine is preferred in patients with both systemic and CNS progression in the third line setting and beyond; on ado-trastuzumab emtansine. However, tucatinib + trastuzumab + capecitabine and it may be given in the second-line setting.
      • Footnote removed: Fam-trastuzumab deruxtecan-nxki is preferred in patients with visceral metastases if progression on ado-trastuzumab emtansine.
      • Trastuzumab + docetaxel dose/administration, second bullet modified: Docetaxel 35 mg/m2 IV days 1, 8, and 15 weekly cycled every 28 days (BINV-Q, 5 of 8)
      • Trastuzumab + lapatinib dose/administration, first bullet modified: Lapatinib 1000 mg PO daily for 21 days (BINV-Q, 6 of 8)
  • Principles of Monitoring Metastatic Disease (BINV-S, 3 of 3)
    • Bone scan, frequency modified for those receiving endocrine therapy to: Every 2–6 months.
  • Phyllodes Tumors (PHYLL-1)
    • After excisional biopsy, moved benign phyllodes tumor to separate pathway, recommending clinical follow-up for 3 y.
  • Inflammatory Breast Cancer (IBC-2)
    • Added to "no response" pathway: Patients may be candidates for multiple lines of systemic therapy to palliate advanced breast cancer. At each reassessment clinicians should assess value of ongoing treatment, the risks and benefits of an additional line of systemic therapy, patient performance status, and patient preferences through a shared decision-making process.



 

NCCN has published updates to the NCCN Guidelines and the NCCN Drugs and Biologics Compendium (NCCN Compendium®) for Acute Myeloid Leukemia. These NCCN Guidelines are currently available as Version 1.2022.

Link directly to the Updates section of the NCCN Guidelines: 
Acute Myeloid Leukemia

Evaluation for Acute Myeloid Leukemia (EVAL-1)

  • 3rd bullet added: B12 and folic acid evaluation
  • 14th bullet added: Consider early integration of palliative care (See NCCN Guidelines for Palliative Care)

Acute Promyelocytic Leukemia (Age ≥18 years)

  • APL (Low Risk) (APL-2)
    • Consolidation therapy, 4th pathway revised: ATRA 45 mg/m2 in 2 divided doses daily.....may be given monthly until 28 weeks from complete response (CR) until achievement of complete molecular response.
  • APL (High Risk) (APL-3A) 
    • Footnote p added: It is important for the management of APL that regimens containing ATRA and arsenic trioxide be administered unless there is a contraindication based on are extenuating patient circumstances. It is important for regimens containing ATRA and arsenic trioxide to be administered for the management of APL. If arsenic is not available or contraindicated, it may be omitted from induction.
  • APL-4A 
    • Footnote z removed: For patients who have prolonged QTc as their sole comorbidity, gemtuzumab ozogamicin could be substituted for anthracycline.


Acute Myeloid Leukemia (Age ≥18 years)

  • AML-1
    • General: Physiologic was removed from age throughout AML section
    • Header clarified as: Age <60 y, Induction eligible  
    • Treatment Strategies
      • 2nd qualifier revised: Intermediate-risk cytogenetics and FLT3-mutated (ITD or TKD) to FLT3/ITD/TKD with intermediate poor-risk genetics
  • AML-1A
    • Footnote c revised: Patients with CBF-AML and core abnormalities may benefit from the addition of gemtuzumab ozogamicin....Gemtuzumab ozogamicin is not beneficial in patients with adverse risk AML.
    • Footnote e added: For CBF-AML leukemia with FLT3 mutation, the panel prefers gemtuzumab ozogamicin.
    • Footnote f added: Gemtuzumab ozogamicin may be beneficial in NPM1-mutated AML (Kapp-Schwoerer S, et al. Blood 2020;136:3041-3050).
    • Footnote p added: An FDA-approved biosimilar is an appropriate substitute for filgrastim.
    • Footnote s added: Outcomes with unfavorable-risk cytogenetics and TP53-mutated AML remain poor with conventional induction chemotherapy (Rücker FG, et al. Blood 2012;119:2114- 2121). Consider clinical trials, azacitidine/venetoclax (DiNardo CD, et al. N Engl J Med 2020;383:617-629), or a 10-day course of decitabine (Welch JS, et al. N Engl J Med 2016;375:2023-2036).
    • Footnote u revised by removing: However, one study showed that high-dose cytarabine may improve the outcome for younger patients. Willemze R, et al. J Clin Oncol 2014;32:219-228.
  • AML-2 - AGE <60 y AFTER STANDARD-DOSE CYTARABINE INDUCTION/RE-INDUCTION
    • Significant cytoreduction with low % residual blasts, 3rd bullet added: Intermediate or high-dose cytarabine
  • AML-4
    • Post-Remission/Maintenance Therapy header revised as Consolidation Therapy
    • CBF cytogenetic translocations, 1st bullet revised:  ...on day 1 x 2 cycles (CD33-positive, NPM1 positive, FLT3 negative)
    • Intermediate-risk cytogenetics and Treatment-related disease other than CBF, moved maintenance therapy option to AML-10: Maintenance therapy with oral azacitidine 300 mg PO once daily on days 1–14 of each 28-day cycle until progression or unacceptable toxicity (if patients decline or are not fit/ eligible for allogeneic HCT)
  • AML-5
    • Treatment strategies, 2nd pathway revised: FLT3/ITD/TKD mutated (ITD or TKD) with intermediate/ poor-risk cytogenetics
  • AML-6 - AGE ≥60 y TREATMENT INDUCTION
    • IDH1 or IDH2 mutation, for both preferred and other recommended, the venetoclax-based regimen moved to first bullet.
  • AML-8
    • Post-Remission/Maintenance Therapy header revised as Post-Induction Therapy
    • After complete response, the pathway was split by "Able to receive conventional consolidation" and "Not able to receive any or all of recommended consolidation." 
    • Maintenance therapy options moved to not able to receive any or all of recommended consolidation.
      • Maintenance therapy with oral azacitidine 300 mg PO once daily on days 1–14 of each 28-day cycle until progression or unacceptable toxicity was changed from a category 2A to a category 1, preferred recommendation.
      • Maintenance therapy with hypomethylating regimens every 4–6 weeks until progression, decitabine changed from a category 2A to a category 2B recommendation.
  • AML-8A
    • Footnote nnn was revised from, "This is a maintenance therapy and is not intended to replace consolidation chemotherapy, which can be curative in some cases. In addition, fit patients with intermediate- and/or adverse-risk cytogenetics may benefit from HCT in first CR, and there are no data to suggest that maintenance therapy with oral azacitidine can replace HCT. The panel also notes that the trial did not include younger patients or those with with CBF-AML; it was restricted to patients ≥55 years of age with intermediate or adverse cytogenetics who were not felt to be candidates for HCT. Most patients received at least 1 cycle of consolidation prior to starting oral azacitidine. Wei AH, et al. Blood 2019;134 (Suppl_2):LBA-3 Wei AH, et al. N Engl J Med 2020;383:2526-2537."
    • Footnote ooo was revised: An option for patients who had achieved a remission with a more intensive regimen but had regimen-related toxicity that prevented them from receiving more conventional consolidation. Azacitidine: Huls G, et al. Blood 2019;133:1457-1464; Decitabine: Boumber Y, et al. Leukemia 2012;26:2428–3241.
  • AML-10 MAINTENANCE THERAPY
    • Added: Post allogeneic stem cell transplantation, in remission, and history of FLT3-ITD with the option of FLT3 inhibitor maintenance with sorafenib as a category 2A recommendation.
    • Clarified criteria for oral azacitidine as 
      • Patient with intermediate or adverse risk disease:
      • Who received prior intensive chemotherapy and is now in remission
      • Completed no consolidation, some consolidation or a recommended course of consolidation and
      • No allogeneic stem cell transplant is planned
    • Added: Neither of the above scenarios is applicable with the recommendation for maintenance therapy as not recommended.
  • AML-A 2 of 4 FAMILIAL GENETIC ALTERATIONS IN AML
    • New page added related to predisposition to AML.
  • AML-H - RESPONSE CRITERIA DEFINITIONS FOR ACUTE MYELOID LEUKEMIA
    • Statement added: These response criteria were defined in the context of intensive chemotherapy regimens, and may not be predictive of outcomes for patients who receive other therapies.
  • AML-I - THERAPY FOR RELAPSED/REFRACTORY DISEASE
    • Footnote 8 added: An FDA-approved biosimilar is an appropriate substitute for filgrastim.
  • AML-J - PRINCIPLES OF VENETOCLAX USE WITH HMA OR LDAC
    • General, 2nd bullet revised from, "Reduction in duration of HMA and LDAC or venetoclax treatment can be considered, particularly when there are delays in count recovery" to "Where there are delays in count recovery, reduction in duration of venetoclax and/or reduction in dose or duration of HMA or LDAC should be considered."
    • Therapy for Newly Diagnosed Patients
      • Prior to therapy sub-bullets revised: 
        • To decrease the risk of severe tumor lysis syndrome (TLS), aim try to achieve WBC count of <25,000/mcL with hydroxyurea/leukapheresis if necessary.
        • Administer Initiate both therapies of the combination concomitantly.
        • If azole antifungal prophylaxis or other CYP enzyme interacting medications are concurrently indicated, reduce venetoclax dose accordingly.
    • First Cycle Considerations
      • TLS monitoring, 2nd sub-bullet revised by adding: Concomitant interacting medications may require changes to these dosages.
      • TLS monitoring, 4th sub-bullet revised: For patients with proliferative disease, monitor blood chemistries every 6–8 hours after initiation; if within normal limits, recheck once daily and continue monitoring until no further risk of TLS.
      • 3rd sub-bullet revised: If no morphologic remission (persistent marrow blasts above 5%)...
    • Cycle 2 and beyond
      • 3rd sub-bullet added: If persistent disease after cycle 1, repeat marrow biopsy following cycle 2 (or subsequent cycles until NED or remission) to again assess for cellularity and disease response, and determine timing of subsequent cycle.
      • 6th sub-bullet revised: If no morphologic remission after cycle 2 or 3, the likelihood of response is decreased and patients could consider

Blastic Plasmacytoid Dendritic Cell Neoplasm

  • BPDCN-1
    • Evaluation/Workup, 5th bullet revised from LP to rule out CNS disease; follow with IT prophylaxis if clinically indicated" to "All patients require a diagnostic LP at the time of initial diagnosis, at disease relapse, or any other time when there is a clinical suspicion for CNS involvement. Follow with IT treatment prophylaxis as clinically indicated (see BPDCN-B)."
  • BPDCN-B - EVALUATION AND TREATMENT OF CNS DISEASE
    • Recommendations added for treatment with and without CNS disease






NCCN has published updates to the NCCN Guidelines for Prostate Cancer. These NCCN Guidelines are currently available as Version 2.2022.

Link directly to the Updates section of the NCCN Guidelines: 
Prostate Cancer

  • Initial Risk Stratification and Staging Workup for Clinically Localized Disease (PROS-2):
    • Very low risk group:
      • Bullet revised under Additional Evaluation: Consider confirmatory prostate biopsy ± mpMRI ± prostate biopsy if MRI not performed initially. All patients should undergo a confirmatory prostate biopsy within 1-2 years of their diagnostic biopsy. prior to biopsy to establish candidacy for active surveillance
    • Low risk group:
      • Bullet revised under Additional Evaluation: Consider confirmatory prostate biopsy ± mpMRI ± prostate biopsy and/or molecular tumor analysis if MRI not performed initially prior to biopsy to establish candidacy for active surveillance. All patients should undergo a confirmatory prostate biopsy within 1-2 years of their diagnostic biopsy.
    • Intermediate risk group:
      • Bullet revised under Additional Evaluation: Consider confirmatory prostate biopsy ± mpMRI ± prostate biopsy and/or molecular tumor analysis if MRI not performed initially prior to biopsy for those considering active surveillance. All patients should undergo a confirmatory prostate biopsy within 1-2 years of their diagnostic biopsy.
  • Very-Low-Risk Group (PROS-3):
    • First bullet removed under Active Surveillance: Consider confirmatory prostate biopsy with or without mpMRI to establish candidacy for active surveillance.
    • Bullets added under Active Surveillance:
      • Consider confirmatory mpMRI ± prostate biopsy if MRI not performed initially.
      • All patients should undergo a confirmatory prostate biopsy within 1-2 years of their diagnostic biopsy.
  • Low-Risk Group (PROS-4):
    • Initial Therapy:
      • Revised: Active surveillance (preferred for most patients)
      • First bullet removed under Active Surveillance: Consider confirmatory prostate biopsy with or without mpMRI and with or without molecular tumor analysis to establish candidacy for active surveillance (also applies to PROS-5).
      • Bullets added under Active Surveillance:
        • Consider confirmatory mpMRI +/- prostate biopsy and/or molecular tumor analysis if MRI not performed initially
        • All patients should undergo a confirmatory prostate biopsy within 1-2 years of their diagnostic biopsy (also applies to PROS-5)
      • Footnote added: The panel recognizes that there is heterogeneity across the low-risk group, and that some factors may be associated with an increased probability of near-term grade reclassification, including high PSA density, a high number of positive cores (eg, ≥3), high genomic risk (from tissue-based molecular tumor analysis), and/or a known BRCA2 germline mutation. In some of these cases, upfront treatment with radical prostatectomy or prostate radiation therapy may be preferred based on shared decision-making with the patient. See Principles of Active Surveillance and Observation (PROS-E).
  • Favorable Intermediate-Risk Group (PROS-5):
    • Footnote added: Particular consideration to active surveillance may be appropriate for those patients in the favorable intermediate risk group with a low percentage of Gleason pattern 4 cancer, low tumor volume, low PSA density, and/or low genomic risk (from tissue-based molecular tumor analysis). See Principles of Active Surveillance and Observation (PROS-E).
  • Principles of Active Surveillance and Observation (PROS-E)
    • This section has been extensively revised.
  • ADT for Clinically Localized (N0,M0) Disease (PROS-H 1 of 5):
    • Sixth bullet, first sub-bullet, and two subsequent sub-bullets added:
      • Abiraterone should be given with concurrent steroid:
        • Prednisone 5 mg orally once daily for the standard formulation.
        • Methylprednisolone 4 mg orally twice daily for the fine-particle formulation (category 2B). 
  • ADT for M0 PSA Persistence/Recurrence After RP or EBRT (ADT for M0 Castration-Naïve Disease) (PROS-H 2 of 5):
    • Seventh bullet, second sub-bullet revised: M0 Radiation Therapy EBRT PSA Recurrence, TRUS-biopsy negative or M0 PSA Recurrence after progression on salvage EBRT



 

NCCN has published updates to the NCCN Chemotherapy Order Templates (NCCN Templates®) for Breast Cancer to reflect the currently published NCCN Guidelines for Breast Cancer v1.2022.

  •  The following NCCN Templates® have been DELETED:
    • BRS37: PACLItaxel + Bevacizumab
    • BRS122: Toremifene






NCCN has published updates to the NCCN Templates® for Acute Myeloid Leukemia to reflect the currently published NCCN Guidelines for Acute Myeloid Leukemia v1.2022.

  • The following NCCN Templates has been DELETED:
    • AML14: Standard-Dose Cytarabine/DAUNOrubicin (7 + 3) – Re-Induction
  • The following NEW NCCN Templates have been published:
    • AML62: High-Dose Cytarabine/MitoXANTRONE – Relapsed/Refractory
    • AML63: High-Dose Cytarabine + Gemtuzumab ozogamicin – Consolidation
    • AML65: Fludarabine/High-Dose Cytarabine/IDArubicin/Gemtuzumab ozogamicin/Filgrastim - Induction
    • AML69: High-Dose Cytarabine/DAUNOrubicin - Relapsed/Refractory
    • AML70: High-Dose Cytarabine/IDArubicin - Relapsed/Refractory
    • AML71: SORAfenib Maintenance
  • References have been updated for the following templates:
    • AML3: High-Dose Cytarabine/DAUNOrubicin/Etoposide
    • AML4: High-Dose Cytarabine/IDArubicin/Etoposide
    • AML15: LDAC (Low-Dose Cytarabine) – Subcutaneous
    • AML16: AzaCITIDine (Low-intensity)
    • AML17: Decitabine (Low-intensity)
    • AML44: Decitabine/SORAfenib (Low-Intensity)
  • Changes to the Indication section have been made on the following templates:
    • AML13: Standard-Dose Cytarabine/DAUNOrubicin (7 + 3) – Induction/Re-Induction (≥60 years)
    • AML28: Intermediate-Dose Cytarabine – Consolidation
    • AML43: AzaCITIDine/SORAfenib (Low-Intensity)
    • AML44: Decitabine/SORAfenib (Low-Intensity)
    • AML48: Liposomal DAUNOrubicin and Cytarabine – Induction or Re-Induction
    • AML52: Gemtuzumab ozogamicin – Induction or Consolidation
    • AML57: Venetoclax/Decitabine – Induction or Consolidation
    • AML58: Venetoclax/AzaCITIDine – Induction or Consolidation
    • AML59: Venetoclax/Low-Dose Cytarabine – Induction or Consolidation
    • AML64: Oral AzaCITIDine
  • Emetic Risk has been updated on the following templates:
    • AML3: High-Dose Cytarabine/DAUNOrubicin/Etoposide
    • AML4: High-Dose Cytarabine/IDArubicin/Etoposide
    • AML46: Standard-Dose Cytarabine/DAUNOrubicin + Gemtuzumab ozogamicin – Induction
    • AML64: Oral AzaCITIDine
  • Changes to the Chemotherapy Regimen section have been made on the following templates:
    • AML2: Standard-Dose Cytarabine/DAUNOrubicin (7 + 3) – Induction/Re-Induction (<60 years)
    • AML3: High-Dose Cytarabine/DAUNOrubicin/Etoposide
    • AML4: High-Dose Cytarabine/IDArubicin/Etoposide
    • AML7: Standard-Dose Cytarabine/MitoXANTRONE (7 + 3) – Induction or Re-Induction
    • AML13: Standard-Dose Cytarabine/DAUNOrubicin (7 + 3) – Induction/Re-Induction (≥60 years)
    • AML15: LDAC (Low-Dose Cytarabine) – Subcutaneous
    • AML46: Standard-Dose Cytarabine/DAUNOrubicin + Gemtuzumab ozogamicin – Induction
    • AML57: Venetoclax/Decitabine – Induction or Consolidation
    • AML58: Venetoclax/AzaCITIDine – Induction or Consolidation
    • AML59: Venetoclax/Low-Dose Cytarabine – Induction or Consolidation
    • AML60: Glasdegib/Low-Dose Cytarabine – Induction or Consolidation
    • AML61: Gilteritinib
  • The following note has been updated in the Antiemetic Therapy section on the following templates:
    • The dexamethasone dose may be modified or omitted. The inclusion of steroids as a scheduled antiemetic for acute leukemia regimens is controversial secondary to their immunosuppressive effects.
      • AML52: Gemtuzumab ozogamicin – Induction or Consolidation
      • AML54: Gemtuzumab ozogamicin – Relapsed/Refractory
      • AML57: Venetoclax/Decitabine – Induction or Consolidation
      • AML59: Venetoclax/Low-Dose Cytarabine – Induction or Consolidation
      • AML64: Oral AzaCITIDine
  • 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
    • Clofarabine
    •  Cytarabine
    • DAUNOrubicin
    • Decitabine
    • Enasidenib
    • Fludarabine
    • Gilteritinib
    • Hydroxyurea
    • IDArubicin
    • Liposomal DAUNOrubicin and cytarabine
    • Midostaurin
    • MitoXANTRONE
    • SORAfenib






NCCN has published updates to the NCCN Templates for Acute Promyelocytic Leukemia to reflect the currently published NNCCN Guidelines for Acute Myeloid Leukemia v1.2022.

  • Changes to the Indication section have been made on the following templates:
    • APL17: GIMEMA AIDA 2000/PETHEMA LPA 2005 - Induction - Induction – Tretinoin (ATRA)/IDArubicin
    • APL18: GIMEMA AIDA 2000/PETHEMA LPA 2005 - Consolidation 1 - Consolidation 1 – Tretinoin (ATRA)/IDArubicin
    • APL19: GIMEMA AIDA 2000/PETHEMA LPA 2005 - Consolidation 2 - Consolidation 2 – Tretinoin (ATRA)/MitoXANTRONE
    • APL20: GIMEMA AIDA 2000/PETHEMA LPA 2005 - Consolidation 3 - Consolidation 3 – Tretinoin (ATRA)/IDArubicin
    • APL27: Arsenic
    • APL28: Tretinoin (ATRA)/Arsenic
    • APL29: Arsenic Consolidation for Second Remission
    • APL30: French-Belgian-Swiss APL 2000 - Methotrexate and Cytarabine Intrathecal Prophylaxis
    • APL41: North American Intergroup Study C9710 or PETHEMA LPA 2005 or APML4 Study. - Methotrexate and Cytarabine Intrathecal
    • APL51: Arsenic + Gemtuzumab ozogamicin with or without Tretinoin (ATRA)
  • Emetic Risk has been updated on the following templates:
    • APL9:  PETHEMA LPA 2005 - Induction – Tretinoin (ATRA)/IDArubicin
    • APL19: GIMEMA AIDA 2000/PETHEMA LPA 2005 - Consolidation 2 - Consolidation 2 – Tretinoin (ATRA)/MitoXANTRONE
    • APL31: APML4 Study - Induction – Tretinoin (ATRA)/IDArubicin/Arsenic OR First Relapse: Early relapse after tretinoin (ATRA) or arsenic only
    • APL37: GIMEMA AIDA-2000 - Maintenance - Tretinoin (ATRA)/Methotrexate/Mercaptopurine
    • APL39: PETHEMA LPA 2005 - Maintenance - Tretinoin (ATRA)/Methotrexate/Mercaptopurine
  • Febrile Neutropenia Risk has been updated on the following templates:
    • APL27: Arsenic
    • APL28: Tretinoin (ATRA)/Arsenic
    • APL29: Arsenic Consolidation for Second Remission
    • APL30: French-Belgian-Swiss APL 2000 - Methotrexate and Cytarabine Intrathecal Prophylaxis
    • APL31: APML4 Study - Induction – Tretinoin (ATRA)/IDArubicin/Arsenic OR First Relapse: Early relapse after tretinoin (ATRA) or arsenic only
    • APL41: North American Intergroup Study C9710 or PETHEMA LPA 2005 or APML4 Study. - Methotrexate and Cytarabine Intrathecal
    • APL42: AML17 - Induction - Tretinoin (ATRA)/Arsenic
    • APL43: AML17 - Consolidation - Tretinoin (ATRA)/Arsenic
    • APL46: AML17 - Induction – Tretinoin (ATRA)/Arsenic + Gemtuzumab ozogamicin
    • APL47: AML17 - Consolidation – Tretinoin (ATRA)/Arsenic +/- Gemtuzumab ozogamicin
    • APL51: Arsenic + Gemtuzumab ozogamicin with or without Tretinoin (ATRA)
    • APL52: Arsenic/IDArubicin with or without Tretinoin (ATRA)
    • APL53: Arsenic/DAUNOrubicin with or without Tretinoin (ATRA)
  • Changes to the Chemotherapy Regimen section have been made on the following templates:
    • APL2: Consolidation – Tretinoin (ATRA)/Arsenic
    • APL9: PETHEMA LPA 2005 - Induction – Tretinoin (ATRA)/IDArubicin
    • APL10:  PETHEMA LPA 2005 - Consolidation 1 – Tretinoin (ATRA)/IDArubicin/High-Dose Cytarabine
    • APL11: PETHEMA LPA 2005 - Consolidation 2 – Tretinoin (ATRA)/MitoXANTRONE
    • APL12: PETHEMA LPA 2005 - Consolidation 3 – Tretinoin (ATRA)/IDArubicin/Cytarabine
    • APL19: GIMEMA AIDA 2000/PETHEMA LPA 2005 - Consolidation 2 - Consolidation 2 – Tretinoin (ATRA)/MitoXANTRONE
    • APL20: GIMEMA AIDA 2000/PETHEMA LPA 2005 - Consolidation 3 - Consolidation 3 – Tretinoin (ATRA)/IDArubicin
    • APL27: Arsenic
    • APL28: Tretinoin (ATRA)/Arsenic
    • APL30: French-Belgian-Swiss APL 2000 - Methotrexate and Cytarabine Intrathecal Prophylaxis
    • APL38: North American Intergroup Study C9710 - Maintenance - Tretinoin (ATRA)/Methotrexate/Mercaptopurine
    • APL41: North American Intergroup Study C9710 or PETHEMA LPA 2005 or APML4 Study. - Methotrexate and Cytarabine Intrathecal
    • APL44: Induction-Tretinoin (ATRA)/Arsenic + Gemtuzumab ozogamicin 
    • APL45: Consolidation-Tretinoin (ATRA)/Arsenic + Gemtuzumab ozogamicin 
    • APL46: AML17 - Induction – Tretinoin (ATRA)/Arsenic + Gemtuzumab ozogamicin
    • APL47: AML17 - Consolidation – Tretinoin (ATRA)/Arsenic +/- Gemtuzumab ozogamicin
    • APL49: Consolidation- Tretinoin (ATRA) + Gemtuzumab ozogamicin
    • APL51: Arsenic + Gemtuzumab ozogamicin with or without Tretinoin (ATRA)
    • APL52: Arsenic/IDArubicin with or without Tretinoin (ATRA)
    • APL53: Arsenic/DAUNOrubicin with or without Tretinoin (ATRA)
  • The following note has been updated in the Antiemetic Therapy section on the following templates:
    • The dexamethasone dose may be modified or omitted. The inclusion of steroids as a scheduled antiemetic for acute leukemia regimens is controversial secondary to their immunosuppressive effects.
      • APL1: Induction – Tretinoin (ATRA)/Arsenic
      • APL2: Consolidation – Tretinoin (ATRA)/Arsenic
      • APL29: Arsenic Consolidation for Second Remission
      • APL32: APML4 Study - Consolidation 1 – Tretinoin (ATRA)/Arsenic
      • APL33: APML4 Study - Consolidation 2 – Tretinoin (ATRA)/Arsenic
      • APL42: AML17 - Induction - Tretinoin (ATRA)/Arsenic
      • APL43: AML17 - Consolidation - Tretinoin (ATRA)/Arsenic
      • APL44: Induction-Tretinoin (ATRA)/Arsenic + Gemtuzumab ozogamicin 
      • APL45: Consolidation-Tretinoin (ATRA)/Arsenic + Gemtuzumab ozogamicin 
      • APL46: AML17 - Induction – Tretinoin (ATRA)/Arsenic + Gemtuzumab ozogamicin
      • APL47: AML17 - Consolidation – Tretinoin (ATRA)/Arsenic +/- Gemtuzumab ozogamicin
      • APL48: Induction-Tretinoin (ATRA) + Gemtuzumab ozogamicin
      • APL51: Arsenic + Gemtuzumab ozogamicin with or without Tretinoin (ATRA)
  • 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:
    • Arsenic
    • DAUNOrubicin
    • IDArubicin
    • MitoXANTRONE
    • Tretinoin (ATRA)






NCCN has published updates to the NCCN Templates for Blastic Plasmacytoid Dendritic Cell Neoplasm (BPDCN) to reflect the currently published NCCN Guidelines for Acute Myeloid Leukemia v1.2022.

  • Changes to the Indication section have been made on the following templates:
    • BPDCN10: Cytarabine Intrathecal
    • BPDCN11: Methotrexate Intrathecal
  • Changes to the Chemotherapy Regimen section have been made on the following templates:
    • BPDCN7: Venetoclax/Decitabine
    • BPDCN8: Venetoclax/AzaCITIDine
    • BPDCN9: Venetoclax/Low-Dose Cytarabine
    • BPDCN10: Cytarabine Intrathecal
    • BPDCN11: Methotrexate Intrathecal
  • 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:
    • DAUNOrubicin
    • DOXOrubicin
    • IDArubicin
    • VinCRIStine

 

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