Weekly Guideline Update for 4/16/2025

National Cancer Comprehensive Network (NCCN)

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

Breast Cancer Screening and Diagnosis Version 2.2025

The NCCN has updated the discussion section to reflect algorithm changes. Also, they have clarified dense breast tissue on mammography as either heterogeneously or extremely dense breasts.

Multiple Myeloma Version 2.2025

In this update, the NCCN has added that talquetamab-tgvs + teclistamab-cqyv may be useful under certain circumstances as a therapy for relapsed/refractory disease after three prior lines. Moreover, to reduce the risk of cytokine release syndrome, prophylactic tocilizumab may be used.

Obesity Canada

The 2025 Obesity Canada pediatric obesity guideline provides a comprehensive, evidence-based framework emphasizing individualized, family-centered care. It strongly recommends multicomponent behavioral and psychological interventions—including physical activity, nutrition, and psychological support—as the foundation of management, supported by conditional recommendations for pharmacologic (GLP-1 receptor agonists, biguanides) and surgical options (laparoscopic sleeve gastrectomy, Roux-en-Y gastric bypass) in eligible adolescents. Notably, the guideline rejects a stepwise escalation model, advocating instead for shared decision-making based on values, preferences, and clinical judgment. Obesity Canada also recommends against using lipase inhibitors for managing obesity in children. The guidelines also include nine good practice statements emphasizing stigma-free communication, social determinants of health, and the use of multidisciplinary care teams.

World Health Organization (WHO)

The 2025 WHO guidelines on meningitis diagnosis, treatment, and care provide comprehensive, evidence-based recommendations for managing acute community-acquired meningitis in individuals older than one month. The guidelines emphasize early lumbar puncture and integrated CSF analysis, with CSF Gram stain, culture, and PCR as diagnostic cornerstones. Empiric treatment should start promptly with IV ceftriaxone or cefotaxime, adding ampicillin for Listeria risk. Corticosteroids are recommended with the first antibiotic dose in non-epidemic bacterial cases but not during meningococcal epidemics. The guidelines also strongly advocate for sequelae screening and early rehabilitation. Designed for global applicability, the guidance prioritizes implementation in resource-limited settings.

American Society of Clinical Oncology (ASCO)

The 2025 ASCO guideline update on sentinel lymph node biopsy (SLNB) in early-stage breast cancer reflects growing evidence supporting de-escalation of axillary surgery. Routine SLNB may be omitted in select postmenopausal patients aged ≥50 with small (≤2 cm), grade 1–2, hormone receptor–positive, HER2-negative tumors and negative preoperative axillary ultrasound undergoing breast-conserving surgery with whole-breast irradiation. Axillary lymph node dissection (ALND) is not recommended for patients with 1–2 positive sentinel nodes if they receive breast-conserving therapy with radiation or mastectomy with regional nodal irradiation. The update also provides nuanced recommendations for SLNB in special populations (e.g., male, pregnant, obese patients) and supports maintaining systemic therapy and radiotherapy decision-making pathways even when SLNB is omitted.

National Lipid Association (NLA) / American Geriatrics Society (AGS)

The 2025 expert clinical consensus from the NLA and the AGS addresses management of hypercholesterolemia in adults over 75 without established ASCVD. The guidelines underscore that elevated LDL-C remains predictive of ASCVD in this population and support statin therapy in select individuals based on individualized risk-benefit analysis. Emphasizing shared decision-making, the consensus advocates incorporating tools like coronary artery calcium (CAC) scoring, competing risk models, and consideration of frailty, cognition, and life expectancy. Statins are generally well tolerated, with limited evidence of harm regarding muscle symptoms, cognition, or new-onset diabetes, especially with moderate-intensity regimens.

American College of Physicians (ACP)

​The ACP has issued best practice advice on the use of cannabis and cannabinoids for managing chronic noncancer pain. Based on a comprehensive review of existing evidence, the ACP advises clinicians to counsel patients on the potential benefits and harms of such therapies. Particular caution is recommended for adolescents and young adults, individuals with current or past substance use disorders, those with serious mental illnesses, and frail patients at risk of falls, as the harms in these groups likely outweigh potential benefits. The ACP advises against the use of cannabis or cannabinoids in patients who are pregnant, breastfeeding, or actively trying to conceive, as well as against the use of inhaled cannabis for chronic noncancer pain management.

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