Weekly Guideline Update for 2/19/2025

Each Wednesday, I bring you news concerning updates to guidelines and recommendations by professional societies. This list is not all-inclusive, of course, but the following recent updates caught my attention.

If there are any guidelines I have missed this week that you would like to see possibly included in future updates, please email me at jerm@day-storms.com.

National Cancer Comprehensive Network (NCCN)

The NCCN guidelines can be found at www.nccn.org.

• Cervical Cancer Version 3.2025 — The NCCN guidelines include significant updates for stage III-IVA disease, particularly regarding the use of pembrolizumab in combination with chemoradiation. For FIGO 2014 stage III–IVA (IIIA, IIIB, IVA), the addition of pembrolizumab to cisplatin-based or carboplatin-based concurrent chemoradiation is a category 1 recommendation. For select cases of FIGO 2018 stage IIIC with nodal metastasis but without defining tumor characteristics of FIGO 2014 IIIA–IIIB, pembrolizumab is a category 2B option. The guidelines clarify that when FIGO 2018 stage III aligns with FIGO 2014 IIIA/IIIB criteria, pembrolizumab + cisplatin (or carboplatin) should be considered a category 1 recommendation.

American Academy of Pediatrics (AAP)

The updated AAP guidelines on newborn screening for critical congenital heart disease (CCHD) now specify that screening should be performed only on newborns not receiving respiratory support, including those in the NICU, to reduce false-negative results. A screening “pass” now requires both pre- and postductal oxygen saturations to be ≥95%, eliminating the prior allowance for ≥95% in either measurement, which previously led to misclassification. Additionally, the new protocol reduces the number of screening attempts from three to one or two, enhancing sensitivity and ensuring earlier detection of CCHD.

National Institute for Health and Care Excellence (NICE)

The updated NICE guidelines on endometriosis include strengthening the recommendation for transvaginal ultrasound from a weak “consider” to a strong “offer” in primary care to detect ovarian endometriomas and deep endometriosis. Additionally, pelvic MRI is now recommended alongside transvaginal ultrasound in secondary care for diagnosing and assessing deep endometriosis. Referral criteria have been updated, with stronger recommendations to refer suspected or confirmed cases of endometrioma and deep endometriosis to specialist services. Notably, the guidelines now highlight a positive family history in first-degree relatives as a risk factor.

American Association of Clinical Endocrinology (AACE)

The updated AACE guidelines on the pharmacologic management of dyslipidemia include a conditional recommendation for the use of PCSK9 inhibitors (alirocumab, evolocumab) or bempedoic acid in patients with ASCVD or high-risk features who are not at LDL-C targets despite maximally tolerated statin therapy, while discouraging their use in lower-risk populations. Eicosapentaenoic acid (EPA) monotherapy is suggested for hypertriglyceridemia in high-risk individuals, whereas combination EPA/DHA and niacin are strongly recommended against. The LDL-C treatment goal remains <70 mg/dL for high-risk patients, with insufficient evidence to support more aggressive targets.

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