03/06/2017

NCCN has published updates to the NCCN Guidelines, NCCN Guidelines with NCCN Evidence Blocks™, NCCN Compendium®, and NCCN Imaging AUC™ for Malignant Pleural Mesothelioma.

NCCN has published updates to the NCCN Guidelines, NCCN Guidelines with NCCN Evidence Blocks™, NCCN Compendium^®, and NCCN Imaging AUC™ for Malignant Pleural Mesothelioma. These NCCN Guidelines are currently available as Version 1.2017.

• Clinical Assessment (MPM-2)
  • “Mixed histology” moved from “Clinical stage I-III and Epithelial histology” pathway to “Clinical stage IV or Sarcomatoid or Medically inoperable” pathway.
  • Footnote “c” added: “If N2 disease is identified, prognosis with surgery (and other therapy) is substantially diminished. Surgical resection should only be considered in the setting of a clinical trial or at a center with expertise in MPM.” (also on MPM-3).
• Adjuvant Treatment (MPM-3)
  • “RT” added as “optional” following “Pleurectomy/decortication.”
• Principles of Chemotherapy (MPM-A 1 of 2)
  • First-line Combination Chemotherapy Regimens: The regimen Pemetrexed 500 mg/m² day 1/Cisplatin 75 mg/m² day 1/Bevacizumab 15 mg/kg day 1 changed from a category 2A to a category 1 recommendation.
  • Footnote “†” added: “The carboplatin/pemetrexed regimen is recommended for patients with poor PS and/or comorbidities.”
• Principles of Surgery (MPM-C)
  • Bullet 4 modified: “± en-bloc resection of pericardium and/or diaphragm with reconstruction” was added to the first surgical choice for clarification.
  • Bullet 5 modified “Numerous studies have defined sarcomatoid and mixed histology as poor prognostic factors for any surgical or non-surgical treatment of MPM and are contraindications to EPP or P/D.”
• Principles of Radiation Therapy (MPM-D 1 of 3)
  • General Principles; bullet 7 was modified: “RT under such circumstances after P/D is usually not recommended, but may be considered with caution under strict dose limits of organs at risk or IRB approved protocols. Hemithoracic intensity modulated RT after P/D may be considered in centers with experience and expertise in these methods.”
• Principles of Radiation Therapy (MPM-D 2 of 3)
  • Recommended doses removed for “Prophylactic radiation to prevent surgical tract recurrence”
  • Recommended doses added for “Post pleurectomy/decortication, Negative margins, and Microscopic positive margins”
  • Radiation Techniques; bullet 4 modified: “The clinical target volume (CTV) for adjuvant RT after EPP or P/D should encompass the entire pleural surface (for partial resection cases), surgical clips, and any potential sites with residual disease.”

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