NCCN Updates Guidelines for Prevention and Treatment of Cancer-Related Infections

12/05/17

The National Comprehensive Cancer Network (NCCN) recently released updated guidelines for the treatment of cancer-related infections, fever, neutropenia, and other adverse events.

In the “Prevention of Hepatitis B Virus (HBV), Hepatitis C Virus, and Human Immunodeficiency Virus Reactivation Disease” section, the guidelines now call for all patients to be screened prior to induction of immunosuppressive therapy or chemotherapy. Therapy considerations for patients with HBV-positive disease now include consulting with an expert in hepatitis treatment to determine possible antiviral prophylaxis.

For baseline symptoms such as perirectal pain, “Consider imaging such as abdominal/pelvic CT or MRI” was added as an evaluation strategy. Enterococcal coverage was removed as an initial empiric regimen for this symptom. For lung infiltrates at baseline, the first option in initial empiric regimen reads “Consider adding coverage for atypical bacteria (azithromycin, doxycycline, or fluoroquinolone). The sections “Results of Daily Monitoring” and “Follow-Up Therapy” were extensively revised.

As for follow-up therapy for responding disease in a documented infection, multiple recommendations are now given: “Targeted treatment of documented infections should be done” and “Reassessment of empiric Gram-negative therapy should be considered.” The strategy of continued initial antibiotic regimen until neutrophil count greater than or equal to 500 cells/mcL and increasing was removed from this section.

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The section “Antibacterial Agents: Anti-Pseudomonal” was revised. Both cefepime and ceftazidime no longer include “Increased frequency of resistance among Gram-negative rod isolates at some centers” under the spectrum. As for piperacillin/tazobactam, “may result in false-positive galactomannan” was removed as a comment/precaution.

The section “Antifungal Agents: Echinocandins” was extensively revised. As for common indications of tenofovir, “tenofovir alafenamide (TAF) 25 mg PO daily” was added.—Zachary Bessette