04/03/2017

NCCN has published updates to the NCCN Guidelines, NCCN Compendium® and NCCN Templates® for Gastric Cancer

NCCN has published updates to the NCCN Guidelines and NCCN Compendium^® for Gastric Cancer. These NCCN Guidelines are currently available as Version 1.2017. 

• Workup (GAST-1)
  • Footnote "e" is new: "Microsatellite instability and tumor Epstein-Barr virus status are emerging as potential biomarkers for personalized treatment strategies for gastric cancer, but are not currently recommended for clinical care.”
• Postoperative Management (GAST-4)
  • For R0 resection; Node negative revised: " Observation until progression, (if received preoperative chemoradiation)."
  • For R0 resection; Node positive: "Observation until progression, (if received preoperative chemoradiation)" added as an option.
  • For R1 resection patients: "Chemotherapy" and "Consider re-resection" added as options.
• Follow-up/Surveillance (GAST-6)
  • "Pelvic CT with contrast as clinically indicated" added.
• Principles of Systemic Therapy (GAST-F 2 of 11)
  • Perioperative Chemotherapy:  “Fluoropyrimidine and oxaliplatin” added as an option with corresponding footnote, “The use of this regimen and dosing schedules is based on extrapolations from published literature and clinical practice.”
  • Postoperative Chemotherapy: 
    • “Capecitabine and oxaliplatin” changed from category 2A to category 1 with corresponding footnote, “Cisplatin may not be used interchangeably with oxaliplatin in this setting.”
    • “Capecitabine and cisplatin” removed as an option.
• Systemic Therapy for Unresectable Locally Advanced, Recurrent or Metastatic Disease (where local therapy is not indicated) (GAST-F 3 of 11)
  • First-Line Therapy; Other Regimens revised:
    • “Fluorouracil and irinotecan” changed from category 1 to category 2A.
    • “ECF (epirubicin, cisplatin, and fluorouracil)” changed from category 1 to category 2B.
    • “ECF modifications” changed from category 1 to category 2B.
  • Second-Line Therapy; Preferred Regimens
    • “Fluorouracil and irinotecan (if not previously used in first-line therapy)” was added as a category 2A option with the following footnote: “Capecitabine may not be used interchangeably with fluorouracil in regimens containing irinotecan.” Previously, it was listed as a category 2B recommendation under “Other Regimens.”
  • Second-Line Therapy; Other Regimens
    • “Capecitabine and irinotecan” removed as an option.
• Principles of Radiation Therapy: This section was extensively revised. (GAST-G)

The following updates to the NCCN Templates^® have been made to reflect the NCCN Guidelines for Gastric Cancer, Version 1.2017.

• The following templates have been deleted:
  • GAS20: Irinotecan/Capecitabine
  • GAS33: Irinotecan/CISplatin with Concurrent Radiation
  • GAS59: Irinotecan/MitoMYCIN
  • GAS64: MitoMYCIN/Leucovorin/Fluorouracil
  • GAS79: Capecitabine/CISplatin

For the complete updated versions of the NCCN Guidelines, NCCN Guidelines with NCCN Evidence Blocks™, the NCCN Compendium^®, the NCCN Biomarkers Compendium^®, the NCCN Templates^®, and the NCCN Imaging Appropriate Use Criteria (NCCN Imaging AUC™), please visit NCCN.org.