Weekly Guideline Update for 4/30/2025

National Cancer Comprehensive Network (NCCN)

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

Colon Cancer Version 3.2025

The NCCN has removed the recommendation regarding enterostomal therapist for preoperative marking of site from the section on non-metastatic colon cancer appropriate for resection. They have also added a separate, new section on the principles of pharmacogenetics.

Esophageal and Esophagogastric Junction Cancers Version 3.2025

The NCCN updates include the addition of oxaliplatin, paclitaxel, and tislelizumab-jsgr, as well as cisplatin, paclitaxel, and tislelizumab-jsgr as preferred first-line therapy options for squamous cell carcinoma (SCC) with PD-L1 CPS ≥1. Revised recommendations also clarify the use of nivolumab and ipilimumab for PD-L1 CPS ≥1. Specific dosing schedules for the new tislelizumab-based regimens were added, with treatments cycled every 21 days for up to six cycles.

Heart Failure Association (HFA), Heart Failure Society of America (HFSA), and the Japanese Heart Failure Society (JHFS)

The 2024 HFA/HFSA/JHFS joint consensus statement, published on April 22, 2025, revises the role of left ventricular ejection fraction (LVEF) in the diagnosis and management of heart failure (HF), emphasizing a major shift from static, threshold-based classification to a dynamic, trajectory-focused approach. Recognizing the poor reproducibility of LVEF measurements and diminished prognostic value above 45%, the statement advises clinicians to prioritize patterns of LVEF change—such as persistently reduced, worsening, or improving LVEF—over absolute values for diagnosis, risk stratification, and therapeutic decision-making. Notably, therapies such as sodium–glucose cotransporter 2 (SGLT2) inhibitors, mineralocorticoid receptor antagonists, and diuretics can now be initiated without requiring LVEF assessment in patients with suspected de novo HF and elevated natriuretic peptides. Natriuretic peptide testing is recommended for both diagnosis and prognosis of HF. The statement also encourages future integration of advanced imaging and myocardial biomarkers to better characterize cardiac dysfunction across the full spectrum of LVEF.

Royal Australian College of General Practitioners (RACGP) and Healthy Bones Australia

The 2024 RACGP and Healthy Bones Australia guidelines on osteoporosis management emphasize earlier case finding using clinical risk factors and fracture risk calculators (notably FRAX), while reaffirming that widespread population screening remains unsupported. Key updates include a focus on identifying patients at “imminent” or “very high” fracture risk to prioritize early initiation of osteoanabolic therapies (romosozumab or teriparatide), with romosozumab now PBS-listed as first-line therapy for very high-risk individuals. The guidelines stress targeted calcium, vitamin D, and protein supplementation only in deficient or high-risk groups, address transition strategies following denosumab cessation to prevent rebound fractures, and remove strontium from therapeutic options.

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