eBulletin Newsletter

NCCN Flash Updates: NCCN Guidelines^®, NCCN Compendium^®, and NCCN Templates Updated

NCCN has published updates to the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines^®) and the NCCN Drugs & Biologics Compendium (NCCN Compendium^®) for Management of Immunotherapy-Related Toxicities. These NCCN Guidelines^® are currently available as Version 3.2021.

Link directly to the Updates section of the NCCN Guidelines:
NCCN Guidelines for Management of Immunotherapy-Related Toxicities

• Management of CAR T-Cell-Related Toxicities
  • Overview of CAR T-Cell Therapy-Related Toxicities (CART-2)
    • Idecabtagene vicleucel was added.
    • Footnotes regarding median time to and duration of CRS and median time to and duration of neurotoxicity were replaced with footnote a: See Prescribing Information for each agent.
• Cytokine Release Syndrome (CRS)
  • Corticosteroids (CART-3)
    • Grade 1 revised from "N/A" to "For idecabtagene and lisocabtagene, consider dexamethasone 10 mg IV every 24 hours for early-onset CRS (<72 hours after infusion)."
    • Grade 2 revised: For persistent refractory hypotension after 1–2 doses of anti-IL-6 therapy: Consider dexamethasone 10 mg IV every 6 hours (or equivalent) every 12-24 hours depending on product.
    • Grade 3 and 4 revised: Dexamethasone 10 mg IV every 6 hours (or equivalent).
  • Footnotes (CART-3A)
    • Footnote o was revised by adding: For lisocabtagene maraleucel, consider dexamethasone 10 mg IV every 12-24 hours if early-onset CRS. For idecabtagene vicleucel, consider dexamethasone 10 mg IV every 12-24 hours.
    • Footnote r was revised by adding: An FDA-approved biosimilar is an appropriate substitute for filgrastim.
• CAR T-cell–Related Neurotoxicity Treatment (CART-5)
  • Footnote w was revised: For lisocabtagene maraleucel or idecabtagene vicleucel, if ICANS develops less than 72 hours after infusion, consider dexamethasone 10 mg IV every 12-24 hours x 2 doses and reassess.

Previous updates to the NCCN Guidelines Management of Immunotherapy-Related Toxicities can be found in the UPDATES section of the current version.

NCCN has published updates to the NCCN Chemotherapy Order Templates (NCCN Templates^®) for Myeloproliferative Neoplasms to reflect the currently published NCCN Guidelines for Myeloproliferative Neoplasms v1.2021.

• Changes to the Indication section have been made on the following NCCN Templates^®:
  • MPN1: AzaCITIDine
  • MPN2: Decitabine
  • MPN3: Hydroxyurea
  • MPN6: PEGinterferon alfa-2a
  • MPN9: Ruxolitinib
  • MPN11: Fedratinib
  • MPN12: Oral Busulfan
• References have been updated on the following templates:
  • MPN3: Hydroxyurea
  • MPN9: Ruxolitinib
• Changes to the Chemotherapy Regimen section have been made on the following templates:
  • MPN1: AzaCITIDine
  • MPN9: Ruxolitinib
• The following note was deleted from the Other Supportive Therapy section, affected templates are listed below:
  • Risk of serious bacterial, viral, and fungal infections exists during treatment. Refer to drug package insert, individual NCCN disease guideline, and NCCN Guidelines for Prevention and Treatment of Cancer-Related Infections for monitoring, prophylaxis, and/or preemptive therapy recommendations.
    • MPN1: AzaCITIDine
    • MPN2: Decitabine
    • MPN3: Hydroxyurea
    • MPN5: Lenalidomide/PredniSONE
    • MPN6: PEGinterferon alfa-2a
    • MPN8: Thalidomide/PredniSONE
    • MPN11: Fedratinib
    • MPN12: Oral Busulfan
• 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
  • Thalidomide

NCCN has published updates to the NCCN Templates for Rectal Cancer to reflect the currently published NCCN Guidelines for Rectal Cancer v1.2021.

• The following NCCN Templates have been deleted:
  • REC30: Simplified Biweekly Infusional Fluorouracil/Leucovorin
  • REC44: Roswell Park Fluorouracil/Leucovorin
  • REC48: Capecitabine
• The content on the following NCCN Template, REC52- FOLFOXIRI (Fluorouracil Continuous Infusion/Leucovorin/OXALIplatin/Irinotecan), has been split into two templates by indication:
  • REC52: FOLFOXIRI (Fluorouracil Continuous Infusion/Leucovorin/OXALIplatin/Irinotecan) -Perioperative
  • REC95: FOLFOXIRI (Fluorouracil Continuous Infusion/Leucovorin/OXALIplatin/Irinotecan)-Advanced/Metastatic
• The Title has been updated on the following templates to be consistent with NCCN standard naming conventions:
  • REC20: Bevacizumab + CapeOX (Capecitabine/OXALIplatin)
  • REC33: Cetuximab + Irinotecan Every 21 Days
  • REC34: Cetuximab + Irinotecan Every 14 Days
  • REC41: Cetuximab + FOLFIRI (Fluorouracil Continuous Infusion/Leucovorin/Irinotecan)
  • REC54: Cetuximab + mFOLFOX6 (Fluorouracil Continuous Infusion/Leucovorin/OXALIplatin)
  • REC59: Cetuximab + Irinotecan Days 1 and 8 Every 21 Days
  • REC61: Panitumumab + mFOLFOX6 (Fluorouracil Continuous Infusion/Leucovorin/OXALIplatin)
  • REC62: Panitumumab + FOLFIRI (Fluorouracil continuous infusion/Leucovorin/Irinotecan)
  • REC64: Ziv-aflibercept + FOLFIRI (Fluorouracil Continuous Infusion/Leucovorin/Irinotecan)
  • REC65: Ziv-aflibercept + Irinotecan Every 14 Days
  • REC67: Panitumumab + Irinotecan Every 14 Days
  • REC77: Ramucirumab + Irinotecan Every 14 Days
  • REC78: Ramucirumab + FOLFIRI (Fluorouracil Continuous Infusion/Leucovorin/Irinotecan)
  • REC86: Cetuximab + FOLFOXIRI (Fluorouracil Continuous Infusion/Leucovorin/OXALIplatin/Irinotecan)
  • REC87: Panitumumab + FOLFOXIRI (Fluorouracil Continuous Infusion/Leucovorin/OXALIplatin/Irinotecan)
  • REC89: Pertuzumab + Trastuzumab
• Changes to the Indication section have been made to the following templates:
  • REC4: mFOLFOX6 (Fluorouracil Continuous Infusion/Leucovorin/OXALIplatin)
  • REC37: Continuous Infusion Fluorouracil with Concurrent Radiation
  • REC38: Fluorouracil/Leucovorin with Concurrent Radiation
  • REC39: Capecitabine with Concurrent Radiation
  • REC51: Simplified Biweekly Infusional Fluorouracil/Leucovorin + Bevacizumab
  • REC52: FOLFOXIRI (Fluorouracil Continuous Infusion/Leucovorin/OXALIplatin/Irinotecan)
  • REC56: CapeOX (Capecitabine/OXALIplatin)
  • REC88: Lapatinib + Trastuzumab
  • REC89: Pertuzumab + Trastuzumab
• References have been updated for the following templates:
  • REC4: mFOLFOX6 (Fluorouracil Continuous Infusion/Leucovorin/OXALIplatin)
  • REC66: Regorafenib
  • REC90: Entrectinib
• Emetic Risk has been updated on the following templates:
  • REC50: Roswell Park Fluorouracil/Leucovorin + Bevacizumab
  • REC87: Panitumumab + FOLFOXIRI (Fluorouracil Continuous Infusion/Leucovorin/OXALIplatin/Irinotecan)
• Febrile Neutropenia Risk has been updated on the following templates:
  • REC52: FOLFOXIRI (Fluorouracil Continuous Infusion/Leucovorin/OXALIplatin/Irinotecan)
  • REC70: FOLFOXIRI (Fluorouracil Continuous Infusion/Leucovorin/OXALIplatin/Irinotecan) + Bevacizumab
  • REC86: Cetuximab + FOLFOXIRI (Fluorouracil Continuous Infusion/Leucovorin/OXALIplatin/Irinotecan)
  • REC87: Panitumumab + FOLFOXIRI (Fluorouracil Continuous Infusion/Leucovorin/OXALIplatin/Irinotecan)
• Changes to the Chemotherapy Regimen section have been made on the following templates:
  • REC4: mFOLFOX6 (Fluorouracil Continuous Infusion/Leucovorin/OXALIplatin)
  • REC19: CapeOX (Capecitabine/OXALIplatin)
  • REC20: Bevacizumab + CapeOX (Capecitabine/OXALIplatin)
  • REC37: Continuous Infusion Fluorouracil with Concurrent Radiation
  • REC38: Fluorouracil/Leucovorin with Concurrent Radiation
  • REC39: Capecitabine with Concurrent Radiation
  • REC43: Capecitabine + Bevacizumab
  • REC52: FOLFOXIRI (Fluorouracil Continuous Infusion/Leucovorin/OXALIplatin/Irinotecan)
  • REC56: CapeOX (Capecitabine/OXALIplatin)
  • REC66: Regorafenib
  • REC69: IROX (Irinotecan/OXALIplatin) + Bevacizumab
  • REC74: Pembrolizumab
  • REC75: Nivolumab
  • REC80: Nivolumab + Ipilimumab followed by Nivolumab
  • REC89: Pertuzumab + Trastuzumab
  • REC91: Encorafenib + Cetuximab
• 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:
  • Bevacizumab
  • Fluorouracil
  • Larotrectinib
  • Trifluridine and Tipiracil

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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