05/09/2017

NCCN has published updates to the NCCN Guidelines and the NCCN Compendium® for Myeloid Growth Factors

NCCN has published updates to the NCCN Guidelines and the NCCN Drugs & Biologics Compendium (NCCN Compendium^®) for Myeloid Growth Factors. These NCCN Guidelines are currently available as Version 1.2017. 

• Examples of disease settings and chemotherapy regimens with a high risk for febrile neutropenia (MGF-A, 1 of 4)
  • TC (docetaxel, cyclophosphamide) has been moved from the examples of intermediate-risk regimens to the examples of high-risk regimens for breast cancer based on the following reference: Kosaka Y, Rai Y, Masuda N, et al. Phase III placebo-controlled, double-blind, randomized trial of pegfilgrastim to reduce the risk of febrile neutropenia in breast cancer patients receiving docetaxel/cyclophosphamide chemotherapy. Support Care Cancer 2015;23(4):1137-1143.
  • TCH (docetaxel, carboplatin, trastuzumab) has been added to the examples of high-risk regimens for breast cancer based on the following reference: Gilbar P, McPherson I, Sorour N, Sanmugarajah J. High incidence of febrile neutropenia following adjuvant breast chemotherapy with docetaxel, carboplatin and trastuzumab. Breast Cancer Manag 2014;3:327-333.
  • Footnote "a" has been added to regimens that may be recommended in combination with monoclonal antibodies: "Guidelines apply to chemotherapy regimens with or without monoclonal antibodies (eg, trastuzumab, rituximab). There is the potential for increased neutropenia risk with the addition of monoclonal antibodies. Rituximab has been associated with prolonged neutropenia with or without chemotherapy. For details on when monoclonal antibodies are recommended with the regimens listed above in clinical practice, see NCCN Guidelines for treatment by cancer site." (Also on MGF-A, 2 of 4)
  • Dacarbazine-based combination (dacarbazine, cisplatin, vinblastine) has been removed from the examples of high-risk regimens for melanoma.
  • Paclitaxel has been removed from the examples of high-risk regimens for ovarian cancer.
  • DT-PACE ± bortezomib has been moved from the examples of intermediate-risk regimens to the examples of high-risk regimens for multiple myeloma.
• Examples of disease settings and chemotherapy regimens with a high risk for febrile neutropenia (MGF-A, 2 of 4)
  • AC + sequential docetaxel + trastuzumab has been removed from the examples of intermediate-risk regimens for breast cancer.
  • The following regimens have been removed from the examples of intermediate-risk regimens for non-Hodgkin lymphoma:
    • EPOCH (etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin) 
    • EPOCH + IT chemotherapy
    • GDP (gemcitabine, dexamethasone, cisplatin) + rituximab
    • FMR (fludarabine, mitoxantrone, rituximab)
• G-CSF for prophylaxis of febrile neutropenia and maintenance of scheduled dose delivery (MGF-B)
  • The following bullet has been removed: "Beginning pegfilgrastim the day after chemotherapy is preferred. Although same-day administration of pegfilgrastim can be considered in certain circumstances, the results are mixed and better options now exist."

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^®), the NCCN Radiation Therapy Compendium™, and the NCCN Imaging Appropriate Use Criteria (NCCN Imaging AUC™), please visit NCCN.org.