NCCN Updates Clinical Practice Guidelines for Gynecological Cancers
The National Comprehensive Cancer Network (NCCN) has released updated versions of their guidelines for cervical and vulvar cancers.
The guideline for managing cervical cancer were updated for the first time in 2017. The updates include additions and removals of treatment options. In pelvic node-positive and para-aortic lymph node-positive disease, extraperitoneal and laparoscopic lymph node dissection were removed as primary treatment options.
For incidental finding of invasive cancer after a simply hysterectomy, the recommendation “optional pelvic EBRT plus vaginal brachytherapy if large primary tumor, deep stromal invasion and/or LVSI” was removed.
In the therapy for relapse of local/regional recurrence prior to radiation therapy section, “best supportive care” was removed as an option. After the “Therapy for Relapse” treatment options, a new pathway was added for “Recurrence,” which include treatment options “Systemic Therapy or Best supportive care.”
In the principles of imaging section, the guideline recommends considering whole body PET/CT or chest/abdomen/pelvic CT in FIGO Stage IB1 and IB2.
In the section for systemic therapy, a new subsection was added for “Chemoradiation” that includes cisplatin and cisplatin plus fluourouracil. For recurrent or metastatic disease, the second-line option of pembrolizumab was added.
As for the guideline for managing vulvar cancer, updates include therapy options, surveillance preferences, and relapse management. The guideline recommends considering HIV testing, especially in younger patients. “Patients with cervical cancer and HIV should be referred to an HIV specialist and should be treated for vulvar cancer as per these guidelines. Modifications to cancer treatment should not be made solely on the basis of HIV status,” the guideline reads.
For appropriate therapy after relapse, the guideline suggests EBRT as an option for “Margins negative; lymph nodes surgically or clinically removed.” For therapy after recurrence after no prior EBRT, the “Unresectable node(s)” pathway was removed.
In the section for systemic therapy, cisplatin plus gemcitabine was added as a category 2B recommendation and pembrolizumab in the second-line setting for MSI-H/dMMR tumors was added as a category 2B recommendation as well.—Zachary Bessette