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 & Biologics Compendium (NCCN Compendium®), the NCCN Radiation Therapy Compendium™, and the NCCN Imaging Appropriate Use Criteria (NCCN Imaging AUC™) for Head and Neck Cancers. These NCCN Guidelines® are currently available as Version 1.2022. 

Link directly to the Updates section of the NCCN Guidelines:
Head and Neck Cancers

  • The algorithms for "Cancer of the Oral Cavity” have been updated to include recommendations for mucosal lip, and the algorithms for "Cancer of the Lip (mucosa)" have been removed (prior pages LIP-1, LIP-2, LIP-3, LIP-4, and LIP-A).
  • Cancer of the Oral Cavity (including Mucosal Lip)
    • Concurrent systemic therapy/RT has been added as an option for selected T4a patients who decline surgery. (OR-3)
  • Principles of Radiation Therapy for Cancer of the Oropharynx (ORPH-A)
    • RT alone, high risk, fractionation, fourth bullet modified: Hyperfractionation for T2, N0–1 disease: 81.6 Gy/7 weeks (1.2 Gy/fraction, twice daily)
  • Cancer of the Nasopharynx
    • Treatment recommendations for T0 (EBV+)-T1, N1-3; T2-T4, N0-3 have been modified and expanded:
      • T2, N0, M0: Definitive RT ± concurrent systemic therapy if high-risk features (NASO-2)
      • T1–2, N1, M0 or T3, N0 (NASO-2): 
        • Concurrent systemic therapy/RT 
        • Consider induction or adjuvant chemotherapy if high-risk features
      • T3-4, N1-3, M0 or any T, N2-3, M0 (NASO-2):
        • Induction chemotherapy followed by systemic therapy/RT (preferred) (category 1)
        • Concurrent systemic therapy/RT followed by adjuvant chemotherapy
        • Concurrent systemic therapy/RT (category 3)
    • Pathways for T1-T4, N0-3, M1 disease revised and added for: (NASO-3)
      • Oligometastatic disease
      • Widely metastatic and good PS (0-2)
      • Widely metastatic and poor PS (3-4)
    • Footnote added for treatment recommendations: The recommendations are based on clinical trial data for those with EBV-associated nasopharynx cancer. (NASO-2, NASO-3 and NASO-B)
    • Footnote added to define high-risk features: High risk features include bulky tumor volume, high serum EBV DNA copy number. (NASO-2)
    • Systemic Therapy for Nasopharyngeal Cancers (NASO-B)
      • Induction/Sequential Systemic Therapy
        • Preferred regimens: Clarified that gemcitabine/cisplatin is a category 1 recommendation for EBV-associated disease, category 2A for non-EBV-associated disease.
        • Other recommended regimens, option removed: Cisplatin/epirubicin/paclitaxel
      • Systemic Therapy/RT Followed by Adjuvant Chemotherapy
        • Other recommended regimens
          • Cisplatin + RT without adjuvant chemotherapy, "category 2B" has been replaced with the following footnote: Use of cisplatin + RT without adjuvant chemotherapy is a category 3 recommendation for stage T3-4, N1-3, M0 or any T, N2-3, M0 disease; it is a category 2A recommendation for all other stages.
          • Option added: Cisplatin + RT followed by capecitabine (for T4, N1–3 or any T, N2–3) (category 2B)
        • Useful in certain circumstances: Pembrolizumab option modified to clarify that it is recommended for TMB-H tumors [≥10 mut/Mb] (Also on SALI-B)
      • Reirradiation + Concurrent Systemic Therapy, option added: Platinum-based regimens (eg, cisplatin, or carboplatin only if cisplatin ineligible/intolerant)
      • Recurrent, unresectable, oligometastatic, or metastatic disease, other recommended regimens, option added: Cisplatin/gemcitabine + PD-1 inhibitor (eg, pembrolizumab or nivolumab)
  • Very Advanced Head and Neck Cancer
    • M1, PS 2 and persistent disease or progression after treatment with single-agent systemic therapy, options added: Alternate single-agent systemic therapy or palliative RT (ADV-2 and ADV-4)
    • Recurrent or persistent disease, footnote added: Consider next-generation sequencing (NGS) genomic profiling for biomarker identification.
  • Occult Primary
    • Squamous cell carcinoma, adenocarcinoma, and anaplastic/undifferentiated epithelial tumors
      • After workup, two new pathways added:
        • T0 and p16 (HPV)-positive: Treat as oropharyngeal cancer (see ORPH-1)
        • T0 and EBV+ or EBER+: Treat as nasopharyngeal cancer (see NASO-1)
  • Salivary Tumors
    • Footnote for distant metastases modified: For salivary ductal carcinomas and adenocarcinomas, check androgen receptor (AR) status and HER2 status prior to treatment for distant metastases. Check NTRK status for mammary analog secretory carcinoma (MASC). use NGS profiling and other appropriate biomarker testing to check status of androgen receptor (AR), HER2, NTRK, HRAS, PIK3CA, and tumor mutational burden (TMB) prior to treatment. (SALI-4)
    • Systemic therapy for recurrent, unresectable or metastatic salivary gland tumors (SALI-B, 1 of 2)
      • Other recommended regimens added:
        • Paclitaxel (category 2A for non-adenoid cystic carcinoma [ACC]; category 2B for ACC)
        • Carboplatin/paclitaxel
        • Carboplatin/gemcitabine
      • Useful in certain circumstances
        • HER2 targeted therapy for HER2+ tumors, regimen added: Fam-trastuzumab deruxtecan-nxki (category 2B)
  • Principles of Systemic Therapy for Non-Nasopharyngeal Cancers
    • Added to first bullet: Next-generation sequencing (NGS) genomic profiling may be considered to guide patient treatment options, including clinical trials. (SYST-A, 1 of 4)
    • Primary systemic therapy + concurrent RT (SYST-A, 1 of 4)
      • Other recommended regimen: weekly cisplatin has been changed from a category 2B to a category 2A option.
    • Recurrent, unresectable, or metastatic disease (SYST-A, 2 of 4)
      • Other recommended regimens (first- and subsequent-line): Pembrolizumab/platinum (cisplatin or carboplatin)/docetaxel has been changed from a category 2B to a category 2A option.
      • Useful in certain circumstances (first- and subsequent-line), option added: Cetuximab/pembrolizumab (category 2B) 



NCCN has published updates to the NCCN Chemotherapy Order Templates (NCCN Templates®) for Head and Neck Cancers to reflect the currently published NCCN Guidelines for Head and Neck Cancers v1.2022.

  • The following NCCN Template® has been DELETED 
    • HDN57 EpiRUBicin/PACLitaxel/CISplatin Followed by Chemoradiation




NCCN has published updates to the NCCN Templates for Follicular Lymphoma to reflect the currently published NCCN Guidelines for B-cell Lymphomas v5.2021.

  • Changes to the Chemotherapy Regimen section have been made on the following template:
    • FOL25: CVP (Cyclophosphamide/VinCRIStine/PredniSONE) + Obinutuzumab
  • 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:
    • DOXOrubicin
    • VinCRIStine


 

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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