06/28/2017

NCCN has published updates to the NCCN Templates®

NCCN has published the following updates to the NCCN Chemotherapy Order Templates (NCCN Templates^®):

• NCCN Templates^® are now available in XML format using the HL7 FHIR v3.0.0 standard in addition to the PDF format.
  
  
• As a result of a software update, the template display format on https://www.nccn.org/professionals/OrderTemplates/Default.aspx has changed.
  • Templates now appear in a table format and are sortable by regimen title, template ID number, and/or indication(s).
  • A search box is available to filter by a specific regimen title, template ID number, and/or indication.
  • The URL for each individual template has changed as a result of the software update. However, clicking on an old template hyperlink should automatically redirect to the new hyperlink and template PDF.

• Emetic risk for carboplatin at a dose of AUC ≥4 has changed from Moderate to High to reflect the NCCN Guidelines for Antiemesis, Version 1.2017 (85 templates total, list available upon request)
  
  
• The following content has been updated for bendamustine-containing templates to include more information regarding the differences between the two FDA-approved products (new content in bold):
  • Infusion times have been changed to “over 10 or 30 minutes (based on product selection)” in the Chemotherapy Regimen section with a new note to “See Safety Parameters and Special Instructions for additional infusion rate information.”
  • The following notes have been added to the Safety Parameters and Special Instructions section:
    • “The recommended infusion rate is based on product selection. Review drug package insert for specific infusion rate recommendations.”
    • “Bendamustine preparation is based on product selection. Certain bendamustine products should only be prepared using a polypropylene syringe with a metal needle and a polypropylene hub. Parenteral preparation products containing polycarbonate and acrylonitrile-butadiene-styrene (ABS), including many closed system transfer devices, should be avoided. Review drug package insert for additional information and instructions.”
  • The following templates are affected:
    • CLL21 – Bendamustine
    • CLL22 – Bendamustine + Rituximab
    • CLL64 – Ibrutinib/Bendamustine + Rituximab
    • CLL65 – Idelalisib/Bendamustine + Rituximab
    • DBL37 – Bendamustine
    • DBL38 – Bendamustine + Rituximab
    • FOL12 – Bendamustine + Rituximab
    • HDL32 – Bendamustine
    • MCL5 – Bendamustine
    • MCL6 – Bendamustine + Rituximab
    • MUM35 – Bendamustine
    • MUM51 – Lenalidomide/Bendamustine/Dexamethasone
    • MUM73 – Bendamustine/Bortezomib/Dexamethasone
    • PTL26 – Bendamustine
    • SCL23 – Bendamustine
    • WAL14 – Bendamustine + Rituximab
    • WAL18 – Bendamustine

• The following style guide notes for high-dose methotrexate-containing templates have been added/updated to include information about the use of glucarpidase (new content in bold):
  • Other Supportive Therapy – “High-dose methotrexate may cause severe adverse reactions in patients with delayed methotrexate clearance due to impaired renal function. Adverse reactions may involve any organ system; however, some of the most common reactions include nausea and vomiting, diarrhea, mucositis, renal dysfunction, elevated liver enzymes, myelosuppression, and neurologic dysfunction. Use of glucarpidase may be considered in patients with significant renal dysfunction and toxic methotrexate serum concentrations based on institutional standard and drug package insert recommendations.”
  • Monitoring and Hold Parameters – “Methotrexate drug clearance and renal function should be monitored as clinically indicated throughout therapy, including methotrexate serum concentration, urine pH, and urinary output. Adjustment of leucovorin dosing, IV alkaline hydration, and in select cases, addition of glucarpidase may be necessary.”
  • The following templates are affected:
    • BON13a – High-Dose Methotrexate/Ifosfamide/Etoposide
    • BON14a – Methotrexate High-Dose/CISplatin/DOXOrubicin
    • LEPT9 – High-Dose Methotrexate
    • DBL39 – High-Dose Methotrexate
    • MCL17b – High-Dose Methotrexate/Cytarabine + Rituximab (Cycle B)
    • METS2 – High-Dose Methotrexate
    • PCNS1a – High-Dose Methotrexate/VinCRIStine/Procarbazine + Rituximab
    • PCNS2a – High-Dose Methotrexate/VinCRIStine/Procarbazine
    • PCNS3 – High-Dose Methotrexate/High-Dose Cytarabine
    • PCNS4 – High-Dose Methotrexate/Ifosfamide
    • PCNS5 – High-Dose Methotrexate + Rituximab
    • PCNS6a – High-Dose Methotrexate/Temozolomide + Rituximab
    • PCNS7 – High-Dose Methotrexate

• The following style guide content has been updated:
  • The following NEW note for gemcitabine has been added:
    • Renal function should be monitored as clinically indicated for potential dose modification or discontinuation.
    • This change affects all gemcitabine-containing templates (72 templates total, list available upon request)
  • The following NEW note for lenalidomide and pomalidomide has been added:
    • This agent may cause constipation. Evaluate risk prior to initiation of therapy, then monitor for symptoms as clinically indicated for potential dose modification or discontinuation. Patients often require prophylaxis with a bowel regimen (eg, docusate sodium and senna) to maintain normal bowel function.
    • The following templates are affected:
      • HDL48, CLL54, DBL26, FOL19, MCL29, MDS1, MUM2, and MUM12 – Lenalidomide
      • CLL55, DBL31, FOL20, FOL22, and MCL30 – Lenalidomide + Rituximab
      • MUM9, MUM10, and SLCA6 – Lenalidomide/Dexamethasone
      • MUM11 – Lenalidomide/Low-Dose Dexamethasone
      • MUM16 and MUM17 – Bortezomib/Lenalidomide/Dexamethasone
      • MUM45 and SLCA10 – Cyclophosphamide/Lenalidomide/Dexamethasone
      • MUM51 – Lenalidomide/Bendamustine/Dexamethasone
      • MUM59 and MUM60 – Carfilzomib/Lenalidomide/Dexamethasone
      • MUM65 – Elotuzumab/Lenalidomide/Dexamethasone
      • MUM67 – Ixazomib/Lenalidomide/Dexamethasone
      • MUM55 – Pomalidomide
      • MUM56 and SLCA11 – Pomalidomide/Dexamethasone
      • MUM70 – Pomalidomide/Bortezomib/Dexamethasone
      • MUM71 – Pomalidomide/Carfilzomib/Dexamethasone
      • MUM72 – Pomalidomide/Cyclophosphamide/Dexamethasone
  • The following NEW note for regimens with a high risk of febrile neutropenia has been added:
    • For more information on prophylaxis of febrile neutropenia, refer to NCCN Guidelines for Myeloid Growth Factors and Appendix C to the NCCN Templates.
  • The following note has been edited (new content in bold):
    • Hypersensitivity reaction may occur with cumulative infusions. Monitor for and treat hypersensitivity reactions per institutional standard. Based on severity of reaction, adjustment of premedications and infusion rates, implementation of a desensitization protocol or referral to a specialist, or discontinuation of therapy may be warranted. Refer to the "Management of Drug Reactions" algorithm in the NCCN Guidelines for Ovarian Cancer for additional information and recommendations.
    • This change affects all carboplatin, cisplatin, and oxaliplatin-containing templates (294 templates total, list available upon request)
  • The following notes have been relocated from Monitoring and Hold Parameters to Other Supportive Therapy (note content has remained the same):
    • Risk of serious bacterial, viral, fungal, and protozoan infections exists during treatment. Review NCCN Guidelines for Prevention and Treatment of Cancer-Related Infections for monitoring and prophylaxis recommendations.
    • Risk of herpes virus (including varicella zoster) infections exists with therapy. Review drug package insert and NCCN Guidelines for Prevention and Treatment of Cancer-Related Infections for monitoring and prophylaxis recommendations.
    • For rituximab: Risk of hepatitis B reactivation exists with therapy. Review drug package insert and NCCN Guidelines for Prevention and Treatment of Cancer-Related Infections for monitoring and antiviral therapy recommendations.
  • The following notes have been added to the Other Supportive Therapy section of all Mantle Cell Lymphoma templates:
    • Herpes and varicella virus prophylaxis (acyclovir or equivalent) is recommended during treatment.
    • Antipneumocystis prophylaxis (sulfamethoxazole/trimethoprim or equivalent) is recommended until completion of therapy