04/03/2017

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

NCCN has published updates to the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines^®) and the NCCN Drugs & Biologics Compendium (NCCN Compendium^®) for Esophageal and Esophagogastric Cancer. These NCCN Guidelines^® are currently available as Version 1.2017. 

• Squamous Cell Carcinoma
  • Footnote “j” regarding the use of PEG tube was revised: “Percutaneous endoscopic gastrostomy (PEG) tube may be considered for patients with cervical esophagus receiving definitive chemoradiation or for patients with marginally resectable disease. Multidisciplinary expertise is recommended prior to placement of PEG tube.” (ESOPH-2)
  • Primary Treatment Options for Medically Fit Patients (ESOPH-3 and for Adenocarcinoma on ESOPH-12)
    • For pT1b, N0 patients, new footnote “v” added: “Definitive chemoradiation may be an appropriate option for patients who decline surgery.”
  • Response Assessment after Preoperative Chemoradiation or Definitive Chemoradiation (ESOPH-5 and for Adenocarcinoma on ESOSPH-14): Imaging recommendations were revised as listed below:
    • “PET/CT (preferred) or PET (category 2B)”
    • “Chest/abdominal CT scan with contrast and pelvic CT with contrast for distal lesions if clinically indicated (not required if PET/CT is done).”
    • Footnote “y” regarding PET scans revised: “Assessment greater than or equal to 5-6 5–8 weeks after completion of preoperative therapy.”
• Adenocarcinoma
  • Postoperative Management for Patients
    • Node positive (pTis, pT1, pT2, pT3, pT4a): Chemotherapy added as an option. (ESOPH-15)
    • R1 resection after preoperative chemoradiation or chemotherapy (ESOPH-16)
      • “Observation until progression (if received preoperative chemotherapy or chemoradiation)” removed as an option.
      • “Chemotherapy, if received preoperatively” added as an option.
      • “Consider re-resection” added as an option.
• Principles of Systemic Therapy
  • Perioperative Chemotherapy (ESOPH-F 2 of 12)
    • “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.”
    • ECF (epirubicin, cisplatin, and fluorouracil) changed from category 3 to category 2B.
    • ECF modifications changed from category 3 to category 2B.
  • “Capecitabine and oxaliplatin” added as an option for “Postoperative Chemotherapy” with the corresponding footnote, “Cisplatin may not be used interchangeably with oxaliplatin in this setting.”
• Systemic Therapy for Metastatic or Locally Advanced Cancer (where local therapy is not indicated) (ESOPH-F 3 of 12)
  • First-Line Therapy; Other Regimens
    • “Fluorouracil and irinotecan” changed from category 1 to category 2A.
    • ECF (epirubicin, cisplatin, and fluorouracil) changed from category 1 to category 2A.
    • 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 (ESOPH-G)
  • Simulation and Treatment Planning
    • First bullet: Proton beam therapy was included as an appropriate option in clinical settings, with the following new footnote added. “Data regarding proton beam therapy are early and evolving. Ideally, patients should be treated with proton beam therapy within a clinical trial.”
    • Normal Tissue Tolerance Dose-Limits: This section was extensively revised.
• Principles of Palliative/Best Supportive Care
  • Under “Dysphagia” a new bullet was added, “Patients with dysphagia who are not candidates for curative surgery should be considered for palliation of their dysphagia symptoms, based on symptom severity. This can be achieved through multiple modalities, though placement of an esophageal stent is most commonly utilized. In contrast, stent placement is generally not advised in patients who may undergo curative surgery in the future due to concerns that stent-related adverse events may preclude curative surgery in the future."

The following updates to the NCCN Chemotherapy Order Templates (NCCN Templates^®) have been made to reflect the NCCN Guidelines for Esophageal and Esophagogastric Cancer, Version 1.2017.

• The following templates have been deleted:
  • ESO20: Irinotecan/Capecitabine
  • ESO59: Irinotecan/MitoMYCIN
  • ESO64: MitoMYCIN/Leucovorin/Fluorouracil

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.