08/29/2017

NCCN has published updates to the NCCN Guidelines® and the NCCN Compendium® for Bone Cancer

NCCN has published updates to the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) and the NCCN Drugs & Biologics Compendium (NCCN Compendium®) for Bone Cancer. These NCCN Guidelines® are currently available as Version 1.2018. 

• Ewing Sarcoma
  • Primary treatment modified: "Multiagent chemotherapy (category 1) for at least 9 weeks prior to local therapy" (EW-1)
• Osteosarcoma
  • Adjuvant chemotherapy for disease that is determined to be high-grade after wide excision changed from a (category 2B) to a (category 2A) recommendation. (OSTEO-1)
  • Chemotherapy in resected disease with poor-response to initial chemotherapy changed from a 
    (category 2B) to a (category 3) recommendation. (OSTEO-2)
• Systemic Therapy Agents (BONE-B)
  • Pembrolizumab (category 2A) is new to the guidelines for MSI-H/dMMR primary bone tumors
    • Corresponding footnote: “Pembrolizumab is a systemic treatment option for adult and pediatric patients with unresectable or metastatic, microsatellite instability-high (MSI-H) or mismatch repair deficient (dMMR) solid tumors that have progressed following prior treatment and who have no satisfactory alternative treatment options. Not for giant cell tumor of bone or chordoma.
  • Vincristine + irinotecan (category 2A) is new to the guidelines as a second-line therapy for relapsed/refractory or metastatic Ewing sarcoma.
  • The following agents changed from a (category 2A) to a (category 1) recommendation:
    • Ewing sarcoma
      • First-line therapy with VAC/IE (vincristine, doxorubicin, and cyclophosphamide alternating with ifosfamide and etoposide)
    • Osteosarcoma
      • First-line therapy with cisplatin/doxorubicin
      • First-line therapy with MAP (high-dose methotrexate/cisplatin/doxorubicin)
    • Principles of Radiation Therapy (BONE-C)
      • This section of the guidelines has been extensively revised.