Weekly Guideline Update for 3/12/2025

National Cancer Comprehensive Network (NCCN)

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

Breast Cancer Version 2.2025

In the updated NCCN guidelines, datopotamab deruxtecan-dlnk is now explicitly indicated for second- or subsequent-line therapy in patients with prior endocrine-based therapy and chemotherapy for unresectable or metastatic disease, aligning with FDA approval. Additionally, dosing corrections have been made for AC (doxorubicin/cyclophosphamide) followed or preceded by carboplatin + docetaxel. The listing of paclitaxel + trastuzumab + pertuzumab has been corrected to include both preoperative and adjuvant settings.

Genetic/Familial High-Risk Assessment: Breast, Ovarian, Pancreatic, and Prostate Version 3.2025

The discussion section has been modified to better align with algorithm changes.

Neuroendocrine and Adrenal Tumors Version 5.2024

The discussion section has been modified to better align with algorithm changes.

Ovarian Cancer Including Fallopian Tube Cancer and Primary Peritoneal Cancer Version 1.2025

In the 2025 guidelines, hyperthermic intraperitoneal chemotherapy (HIPEC) is now considered for select stage IV patients with a favorable response to neoadjuvant therapy. Revised imaging recommendations emphasize MRI over CT in patients with renal dysfunction, and molecular testing updates now include homologous recombination deficiency (HRD) assessment for patients receiving PARP inhibitors. Additionally, targeted therapy options have expanded, including fam-trastuzumab deruxtecan-nxki for HER2-positive tumors and mirvetuximab soravtansine for folate receptor-alpha (FRα)-expressing tumors. Surveillance and maintenance strategies have been refined, with greater emphasis on individualized treatment for recurrent disease and clinical trial enrollment where appropriate.

American Society of Clinical Oncology (ASCO)

Therapy for Stage IV Non–Small Cell Lung Cancer Without Driver Alterations: ASCO Living Guideline, Version 2024.3

Within the updated guidelines, trastuzumab deruxtecan is now recommended for HER2-overexpressing NSCLC (HER2 IHC 3+) in the second-line setting. Additionally, in the TROPION-Lung01 clinical trial, datopotamab deruxtecan showed improved PFS over docetaxel in pretreated patients with nonsquamous NSCLC, though no OS benefit was observed. The LUNAR study supports Tumor Treating Fields (TTFields) therapy in combination with standard systemic therapy for improved OS post-platinum chemotherapy, particularly in patients treated with immunotherapy. The guidelines continue to emphasize PD-(L)1 inhibitors as first-line therapy, with combination chemotherapy-based regimens tailored to PD-L1 expression levels.

Therapy for Stage IV Non–Small Cell Lung Cancer With Driver Alterations: ASCO Living Guideline, Version 2024.3

Within the ASCO updated guidelines for NSCLC with driver alterations, osimertinib with platinum doublet chemotherapy or amivantamab plus lazertinib is now an option for EGFR Exon 19 deletion and Exon 21 L858R mutations, particularly in patients with high-risk features. In the second-line setting, platinum-based chemotherapy with or without amivantamab is recommended for patients progressing on osimertinib without new targetable alterations. Anti-PD-(L)1 agents, such as ivonescimab, plus chemotherapy has shown improved PFS in EGFR-mutant NSCLC post-TKI therapy. Additionally, ramucirumab plus osimertinib demonstrated potential benefit over osimertinib monotherapy. New approvals, such as repotrectinib for NTRK fusions, are also highlighted.

US Preventive Task Force (USPSTF)

Screening for Food Insecurity

An estimated 12.8% of households in the United States experienced food insecurity in 2022, and an estimated 1 in 20 homes are experiencing very low food security. The USPSTF, at this time, states that there is insufficient evidence to determine the potential benefits and harms of screening for food insecurity within the primary care setting.

Screening for Osteoporosis

The USPSTF gives a “B” recommendation for screening women 65 years or older for osteoporosis to prevent osteoporotic fractures. Likewise, they recommend similar screening for post-menopausal women under the age of 65 years who are at increased risk of osteoporosis (B recommendation). At this time, the USPSTF says that there is insufficient evidence to determine the potential benefits of screening for osteoporosis in men.

American Society for Radiation Oncology (ASTRO)

The first ASTRO clinical guideline for radiation therapy in anal squamous cell carcinoma establishes intensity-modulated radiation therapy (IMRT) with daily image guidance as the preferred technique to reduce toxicity. Concurrent chemoradiation with 5-fluorouracil (5-FU) plus mitomycin (MMC) remains the standard, with capecitabine or cisplatin as alternatives. Local excision may be considered for select early-stage cases, while diversion surgery is an option for patients with obstruction or treatment-limiting symptoms. The guideline emphasizes precise radiation dosing, normal organ dose constraints, and post-treatment surveillance strategies.

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