Weekly Guideline Update for 3/5/2025

National Cancer Comprehensive Network (NCCN)

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

Bladder Cancer Version 7.2024

The updated guidelines now endorse perioperative/sandwich immunotherapy with neoadjuvant cisplatin-based chemotherapy followed by radical or partial cystectomy in select cases. Additionally, a new adjuvant recommendation specifies that patients receiving preoperative gemcitabine + cisplatin + durvalumab should continue durvalumab postoperatively. The guidelines also integrate a new perioperative regimen table, categorizing gemcitabine + cisplatin + durvalumab pre-cystectomy, followed by durvalumab post-cystectomy as a Category 1 recommendation.

Bone Cancer Version 2.2025

The latest version of the NCCN guidelines includes updates to the discussion section to reflect algorithm changes.

Esophageal and Esophagogastric Junction Cancers Version 1.2025

The latest NCCN guidelines introduce several key updates. Preoperative chemoradiation is now the preferred approach for medically fit patients with high-risk cT2, N0 and cT1b–cT2, N+ tumors, while perioperative chemotherapy is now the preferred recommendation over preoperative chemoradiation for adenocarcinoma. Additionally, postoperative checkpoint inhibitor therapy is recommended in select cases following preoperative chemoradiation. Regarding NGS testing, the NCCN states that IHC/ISH/targeted PCR is preferred, but NGS testing may be considered if enough tissue is available for testing. The verbiage regarding liquid biopsy for disease surveillance has been modified to include the possibility when limited tissue is available or for patients who are not able to undergo a traditional biopsy.

Gastric Cancer Version 1.2025

The new NCCN guidelines include has removed preoperative chemoradiation as a primary treatment option for locoregional disease, with perioperative chemotherapy now preferred (category 1). Systemic therapy regimens have been updated, including clarifying dosing schedule for oxaliplatin. Liquid biopsy is recommended for patients when limited tissue is available or who are unable to undergo traditional biopsy.

Vaginal Cancer Version 5.2025

The latest version of the NCCN guidelines includes updates to the discussion section to reflect algorithm changes.

American College of Cardiology (ACC)/American Heart Association (AHA)

The 2025 ACC/AHA Guidelines for Acute Coronary Syndromes (ACS) introduce updates in antithrombotic therapy, lipid management, revascularization strategies, and procedural considerations. Ticagrelor or prasugrel is now preferred over clopidogrel in patients undergoing PCI, and ticagrelor monotherapy may be considered after one month in select patients to reduce bleeding risk. High-intensity statins remain the standard, with earlier integration of ezetimibe or PCSK9 inhibitors for LDL-C levels ≥70 mg/dL. The guidelines now recommend routine radial artery access over femoral access for PCI and emphasize intracoronary imaging for complex lesions. In STEMI, a strategy of complete revascularization is advised over culprit-only PCI. Additionally, microaxial flow pump use in cardiogenic shock is conditionally recommended, balancing reduced mortality with increased bleeding risk. Post-discharge, the guidelines reinforce early lipid reassessment and cardiac rehabilitation, including home-based options.

Department of Veterans Affairs (VA)/Department of Defense (DoD)

The VA/DoD Clinical Practice Guideline Version 3.0 for Rehabilitation of Individuals with Lower Limb Amputation introduces emphasizes a multidisciplinary, patient-centered approach and evidence-based rehabilitation strategies. It is interesting to note that all recommendations are either neutral or “weak for”, meaning that there are no “strong” recommendations. Recommendations include the expanded role of osseointegration for transfemoral amputees meeting eligibility criteria and the use of intraoperative perineural catheters to reduce post-amputation pain. The guideline also reinforces structured rehabilitation in inpatient settings over home-based care, promotes peer support programs to improve psychosocial outcomes, and highlights the importance of cognitive assessment in determining prosthetic candidacy. Additionally, mirror therapy is now recommended for managing phantom limb pain, and updated prosthetic recommendations favor microprocessor knee units for prosthetic ambulators to reduce falls and enhance mobility. These updates reflect a stronger emphasis on personalized rehabilitation pathways, pain management strategies, and advanced prosthetic technologies to optimize long-term function and quality of life.