Weekly Guideline Update for 4/23/2025

National Cancer Comprehensive Network (NCCN)

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

Breast Cancer Version 4.2025

In the latest update to the guidelines, the NCCN downgraded the use of fam-trastuzumab deruxtecan-nxki in HER2-low metastatic breast cancer from a category 1 preferred therapy to a category 2A, other recommended regimen. Revised footnotes now reflect FDA-approved scoring and CAP reporting regarding HER2 test results of IHC. Fam-trastuzumab deruxtecan-nxki is now recommended for patients who have received prior endocrine-based therapy (removing the requirement of HER2 IHC 0+, 1+, or 2+/ISH negative requirement).

Gastrointestinal Stromal Tumors Version 1.2025

The 2025 NCCN Guidelines for Gastrointestinal Stromal Tumors (GIST) emphasize mutation-directed therapy and individualized risk stratification. Key updates include expanded guidance on the use of avapritinib for PDGFRA D842V mutations and updated criteria for neoadjuvant therapy, with new emphasis on assessing treatment response via FDG-PET/CT and MRI. The guidelines reinforce the need for mutation testing (KIT, PDGFRA, SDH, NTRK, BRAF, NF1) to inform TKI selection, and now recommend germline testing in patients with familial or multifocal disease. Surveillance and adjuvant imatinib duration are also tailored by risk, with individualized follow-up after 10 years.

Merkel Cell Carcinoma Version 2.2025

The NCCN has modified the discussion section to align with algorithm changes.

Neuroblastoma Version 1.2025

The updated guidelines emphasize risk-adapted, multimodal treatment strategies tailored by age, histology, MYCN status, DNA ploidy, and segmental chromosomal aberrations. Major updates include guidance on fertility preservation, refined imaging protocols, and expanded recommendations for high-risk patients, including post-consolidation therapy containing anti-GD2 therapy with sargramostim and isotretinoin as a category 1 recommendation. Naxitamab was added as a category 2A option for high-risk disease. The guidelines now incorporate paraneoplastic syndromes and recommend repeat molecular profiling at relapse. Notably, radiation to residual metastatic sites after induction is endorsed based on emerging institutional data.

Prostate Cancer Version 2.2025

In the latest update, the NCCN added lutetium Lu-177 vipivotide tetraxetan (Lu-177–PSMA-617) for PSMA-positive metastases.

Consolidated Standards of Reporting Trials (CONSORT)

The CONSORT 2025 statement provides an updated, evidence-based framework for reporting randomized trials. The guideline comprises a 30-item checklist and participant flow diagram. This update incorporates recent methodological advances and harmonizes content with the SPIRIT 2025 protocol guidelines. Major revisions include seven new checklist items (e.g., data sharing, patient involvement, harms assessment, conflict of interest reporting), three revised items (e.g., access to statistical analysis plans), and integration of items from prior CONSORT extensions. A new “Open Science” section promotes transparency through trial registration, protocol availability, and disclosure of conflicts of interest. The checklist aims to ensure clear, complete, and reproducible trial reporting, facilitating appraisal and interpretation by clinicians, editors, and policy-makers​.

American Urological Association (AUA)

The AUA has published parts I through III of their guidelines on male chronic pelvic pain. Unfortunately, the AUA keeps the guidelines behind a paywall with strict rules and regulations regarding reporting and using their guidelines; consequently, only a link will be provided below for each guideline. (Check out our previous thoughts regarding placement of guidelines behind firewalls in a previous edition of the weekly newsletter.)

• Male Chronic Pelvic Pain: AUA Guideline: Part I Evaluation and Management Approach
• Male Chronic Pelvic Pain: AUA Guideline: Part II Treatment of Chronic Prostatitis/Chronic Pelvic Pain Syndrome
• Male Chronic Pelvic Pain: AUA Guideline: Part III Treatment of Chronic Scrotal Content Pain

American Pharmacists Association (APhA)

The APhA’s 2025 recommendations for advancing pharmacist service coverage under the medical benefit urge systemic reform at federal, state, and commercial levels. The guidance emphasizes pharmacist-provider recognition in Medicare and Medicaid, standardization of scope of practice across states, and integration into health plan accreditation, enrollment, and billing processes. Health plans are encouraged to reimburse pharmacists equitably across settings, partner in value-based care models, and engage in collaborative contracting structures. Pharmacists, in turn, should be prepared to navigate various payment models, credentialing, and medical billing systems. Alignment around terminology, performance measures, and infrastructure development is critical to scaling sustainable pharmacist-delivered care.

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