Each year the National Comprehensive Cancer Network (NCCN) presents the latest updates to its Clinical Practice Guidelines in Oncology, as well as the latest cancer therapies by key opinion leaders. This year’s event, held at The Westin Diplomat in Hollywood, Florida, from March 9-13, 2011, featured two roundtable discussions: (1) “The Many Faces and Challenges of Caregivers” hosted by former ABC newsman Sam Donaldson (to watch the roundtable video in its entirety, go to http://bit.ly/hV6H5x
); and (2) “Molecular Testing: Implications for Practice and Policy” hosted by Clifford Goodman, PhD, senior vice president of the Lewin Group.
In addition to the NCCN Guidelines Update sessions and the roundtables, there were other sessions on topics such as hepatitis B screening and chemotherapy, imaging techniques, and radiation oncology. However, it is the NCCN Guidelines Update sessions that generate the most attention and discussion.
According to an NCCN spokeswoman, there were nearly 1800 oncologists, fellows, nurses, pharmacists, and other healthcare professionals at the meeting. In a welcome letter to attendees, William T. McGivney, PhD, the CEO of NCCN, noted that the Clinical Practice Guidelines in Oncology are the “recognized standard for clinical policy in the oncology community.” According to McGivney, the NCCN’s Guidelines cover the treatment of more than 97% of all cancer patients.
A brief summary of the 2011 updates to the NCCN Guidelines are provided below by cancer type.
Robert W. Carlson, MD
Stanford Comprehensive Cancer Center
“Considering there are limited options for women with metastatic breast cancer who have already received other therapies, [eribulin] is a noteworthy treatment option that the Panel felt was important to incorporate into the Guidelines.”
Eribulin (Halaven) has been added as a preferred single-agent option in the treatment of metastatic disease.
Denosumab (Xgeva) has been included in the guidelines as an additional option for the prevention of skeletal-related events.
A footnote was added discouraging axillary lymph node dissection in certain women with early breast cancer and a minimal number of positive lymph nodes.
Bevacizumab (Avastin), in combination with paclitaxel (Taxol), continues to be endorsed as treatment for patients with stage IV breast cancer.
With available study results being “inconsistent,” Dr Carlson noted that testing for CYP2D6 polymorphisms in order to determine the efficacy of tamoxifen is not recommended at this time.
Kenneth C. Anderson, MD
Dana-Farber Cancer Institute
The serum-free light chain assay and the fluorescence in situ hybridization (FISH) for 1q21 amplification are now a recommended part of the initial diagnostic workup.
The combination of bortezomib/ cyclophosphamide/ dexamethasone has been added as primary induction therapy for transplant candidates.
The bortezomib /dexamethasone combination and the melphalan/ prednisone/lenalidomide combination have been included as therapy for primary induction for nontransplant candidates.
The combinations of bortezomib/ cyclophosphamide/ dexamethasone and cyclophosphamide/ lenalidomide/ dexamethasone are now recommended for salvage therapy.
The combinations of bortezomib/ dexamethasone and cyclophosphamide/ thalidomide/ dexamethasone have been added to the guidelines as initial treatment for amyloidosis.
Daniel G. Coit, MD
Memorial Sloan-Kettering Cancer Center