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^®). These NCCN Guidelines^® for Myelodysplastic Syndromes are currently available as Version 3.2022.

Link directly to the Updates section of the NCCN Guidelines:
Myelodysplastic Syndromes

Initial Evaluation (MDS-1)

• Bullet 12 revised: ...particularly in patients younger than 40 50 years of age.

Supportive Care (MDS-7) 

• Revised sub-bullet: Transfusion products should be irradiated with 25 Gy or per institution standard.
• Revised sub-bullet: Patients with ≥5% marrow blasts who are candidates for reduced-intensity conditioning (RIC) should receive are encouraged to receive "debulking" therapy with HMA or induction chemotherapy.

Prognostic Scoring Systems (MDS-B, page 2 of 3)

• Added links for WPSS risks.

Discussion (MS-1)

• The Discussion was updated to reflect the changes in the algorithm. 

**For interim updates, please include the following text: 

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






NCCN has published updates to the NCCN Guidelines, the NCCN Drugs & Biologics Compendium (NCCN Compendium^®), and the NCCN Imaging Appropriate Use Criteria (NCCN Imaging AUC™) for Ovarian Cancer. These NCCN Guidelines are currently available as Version 1.2022. 

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

• Workup (OV-1)
  • Footnote b modified: PET/CT, MRI or PET/MRI may be indicated for indeterminate lesions if results will alter management.
• Monitoring/Follow-up for Recurrent Disease (OV-6)
  • Footnote cc modified: Validated molecular testing should be performed in a CLIA-approved facility using the most recent available tumor tissue. Testing recommended to include at least: BRCA1/2, and microsatellite instability or DNA mismatch repair if not previously done. Evaluation of HR status can be considered. Additional somatic tumor testing can be considered at the physician’s discretion to identify genetic alterations for which FDA-approved tumor-specific or tumor-agnostic targeted therapy options exists. Tumor molecular analysis is recommended to include, at a minimum, tests to identify potential benefit from FDA-approved targeted therapeutics that have tumor-specific or tumor-agnostic benefit including, but not limited to, BRCA1/2, HR status, MSI, TMB, NTRK if prior testing did not include these markers. More comprehensive testing may be particularly important in LCOC with limited approved therapeutic options (See OV-B).
• Less Common Ovarian Cancers (LCOC)
  • Clear Cell Carcinoma of the Ovary (LCOC-3)
    • Stages modified to include observe as an adjuvant option for stage IB and IC1.
  • Low-Grade Serous Carcinoma (LCOC-7)
    • New page added with recommendations for monitoring/follow-up, and treatment for recurrent low-grade serous carcinoma.
  • Ovarian Borderline Epithelial Tumors (Low Malignant Potential) (LCOC-8)
    • After prior complete surgical resection, removed pathway for high-grade serous carcinoma. 
  • Malignant Germ Cell Tumors, Systemic Therapy Regimens (LCOC-A)
    • Recurrence therapy
      • Other recommended regimens added: 
        • Etoposide (oral)
        • Gemcitabine/paclitaxel/oxaliplatin
        • Gemcitabine/oxaliplatin
        • Pembrolizumab (if MSI-H/dMMR or TMB-H)
      • Regimen removed: TIP
      • Regimen modified: Etoposide/cisplatin (EP), if not previously used
  • Sex Cord-Stromal Tumors, Systemic Therapy Regimens (LCOC-A)
    • Recurrence therapy
      • VAC has been changed from a category 2A/other recommended regimen, to a category 2B/useful in certain circumstances option.
      • Added "if not previously used" to EP and BEP.
• Principles of Pathology (OV-B)
  • Section on tumor molecular analyses has been modified to include the following:
    • In the up-front setting, choice of somatic testing should, at a minimum, optimize identification of molecular alterations that can inform use of interventions that have demonstrated benefit in this setting, including BRCA1/2, loss of heterozygosity (LOH), or homologous recombination (HR) status in the absence of a germline BRCA mutation.
    • In the recurrence setting, tumor molecular analysis is recommended to include, at a minimum, tests to identify potential benefit from targeted therapeutics that have tumor-specific or tumor-agnostic benefit including, but not limited to, BRCA1/2, HR status, microsatellite instability (MSI), tumor mutational burden (TMB), and NTRK if prior testing did not include these markers. More comprehensive testing may be particularly important in less common histologies with limited approved therapeutic options. It is recommended that such testing be performed on the most recent available tumor tissue.
• Principles of Systemic Therapy
  • Primary Therapy for Stage I-IV epithelial ovarian/fallopian tube/primary peritoneal cancer (OV-C, 5 & 6 of 11)
    • Option removed: Carboplatin (if elderly [age >70] and/or for those with comorbidities) (Also removed on OV-C, 7 of 11)
    • Low-grade serous (stage IC-IV)/Grade 1 Endometrioid (stage IC-IV), preferred regimens
      • First bullet modified for consistency with recommendations on LCOC-5/6: Paclitaxel/carboplatin q3weeks ± maintenance letrozole (category 2B) or other hormonal therapy (category 2B)
  • Acceptable Recurrence Therapies for Platinum-Resistant and Platinum-Sensitive Epithelial Ovarian (including LCOC)/Fallopian Tube/Primary Peritoneal Cancer (OV-C, 8 & 9 of 11)
    • Useful in certain circumstances
      • Indications modified for the following immunotherapy options:
        • Pembrolizumab (for microsatellite instability-high [MSI-H] or mismatch repair-deficient [dMMR] solid tumors, or patients with tumor mutational burden-high [TMB-H] tumors ≥10 mutations/megabase and no satisfactory alternative treatment options)
        • Dostarlimab-gxly (for dMMR/MSI-H recurrent or advanced tumors if disease progression and no satisfactory alternative treatment options)
      • Option added: Binimetinib, for low-grade serous carcinoma (category 2B)
  • Footnote f added: Albumin-bound paclitaxel may be substituted for those experiencing a hypersensitivity reaction to paclitaxel. However, albumin-bound paclitaxel will not overcome infusion reactions in all patients. (OV-C, 5-9 of 11)

NCCN has published updates to the NCCN Guidelines, NCCN Compendium, for Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma. These NCCN Guidelines are currently available as Version 2.2022.

Link directly to the Updates section of the NCCN Guidelines:
Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma

• Suggested Treatment Regimens
  • CLL/SLL without del(17p)/TP53 mutation, First-Line Therapy (CSLL-D 1 of 6)
    • Patients age ≥65 y OR Patients age <65 y with significant comorbidities and Patients age <65 y without significant comorbidities
      • Zanubrutinib was added as a category 2A, preferred recommendation.
  • CLL/SLL without del(17p)/TP53 mutation, Second-line and Subsequent Therapy (CSLL-D 2 of 6)
    • Patients age ≥65 y OR Patients age <65 y with significant comorbidities and Patients age <65 y without significant comorbidities
      • Zanubrutinib was moved from an Other recommended regimen to a Preferred regimen and the qualifier, "for patients with intolerance or contraindication to other BTKi" was removed.
  • CLL/SLL with del(17p)/TP53 mutation, Second-line and Subsequent Therapy (CSLL-D 3 of 6)
    • Zanubrutinib was moved from an Other recommended regimen to a Preferred regimen and the qualifier, "for patients with intolerance or contraindication to other BTKi" was removed.
• Special Considerations for the Use of Small-Molecule Inhibitors (CSLL-F)
  • Zanubrutinib, Most common adverse events (AEs) (all grades) and Adverse events of special interest (AESI) updated based on Tam C, et al. Zanubrutinib monotherapy for patients with treatment naive chronic lymphocytic leukemia and 17p deletion. Haematologica 2020;106:2354-2363.

NCCN has published updates to the NCCN Chemotherapy Order Templates (NCCN Templates^®) for Chronic Lymphocytic Leukemia to reflect the currently published NCCN Guidelines  for Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma v2.2022.

• Changes to the Indications section have been made on the following template:
  • CLL90: Zanubrutinib
• References have been updated on the following template:
  • CLL90: Zanubrutinib

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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