Each Wednesday, I bring you news concerning updates to guidelines and recommendations by professional societies. This list is not all-inclusive, of course, but the following recent updates caught my attention.
If there are any guidelines I have missed this week that you would like to see possibly included in future updates, please email me at jerm@day-storms.com.
National Cancer Comprehensive Network (NCCN)
The NCCN guidelines can be found at www.nccn.org.
Breast Cancer Risk Reduction Version 2.2025
In the most recent update, the NCCN has updated the discussion section to better align with algorithm changes.
Melanoma: Uveal Version 1.2025
The updated NCCN include changes in risk stratification, metastasis surveillance, and systemic therapy. The classification of distant metastasis risk has been revised, emphasizing PRAME expression as a modifier, with Class 1B tumors or PRAME+ status now categorized as medium risk. Surveillance recommendations specify contrast-enhanced MRI as the most sensitive imaging modality for liver metastases, with alternative imaging options based on institutional expertise. Terminology updates distinguish “hepatic-dominant” versus “non–hepatic-dominant” metastatic disease. Systemic therapy updates include guidance on nivolumab and hyaluronidase-nvhy, now an option for subcutaneous administration in place of IV nivolumab, though not for concurrent use with ipilimumab.
Myeloid/Lymphoid Neoplasms with Eosinophilia and Tyrosine Kinase Gene Fusions Version 1.2025
The updated guidelines expand the recognized clinical presentations of PDGFRB-rearranged neoplasms to include CMML, atypical CML, and MDS/MPN-unclassifiable cases. Diagnostic criteria have been refined to incorporate immunohistochemistry (IHC) for tryptase/CD117/CD25/CD30 and/or flow cytometry for CD117/CD25/CD30/CD2, along with KIT D816V molecular testing. In cases where standard testing does not detect PDGFRA or PDGFRB rearrangements, but the clinical phenotype strongly suggests their presence, the guidelines now support considering imatinib as a treatment option. Additionally, quizartinib has been added as a recommended tyrosine kinase inhibitor for FLT3-mutated disease. The language regarding the use of NGS has been modified to include RNA fusion panels and comparative genomic hybridization to identify gene fusion events that may not be detected by conventional testing methods.
Myeloproliferative Neoplasms Version 1.2025
The NCCN Guidelines Version 1.2025 for Myeloproliferative Neoplasms (MPNs) introduce several updates in diagnostic criteria, risk stratification, and treatment strategies. Notable changes include revisions to bone marrow cytogenetics, now allowing FISH in cases where bone marrow aspiration is not feasible. Updates to risk stratification models for myelofibrosis (MF) incorporate the myelofibrosis transplant scoring system (MTSS) to refine patient selection for allogeneic hematopoietic cell transplant (HCT). The guidelines also redefine anemia management in MF, adjusting ruxolitinib combination strategies and incorporating momelotinib as a preferred regimen in symptomatic patients. In polycythemia vera (PV) and essential thrombocythemia (ET), the role of pegylated interferons has been expanded, with ropeginterferon alfa-2b now a frontline option.
Systemic Mastocytosis Version 1.2025
The latest version of the guidelines includes revised criteria to align with the WHO 5th Edition and International Consensus Classification (ICC), refining diagnostic thresholds, including the REMA score for bone marrow biopsy necessity. The recommendation regarding cladribine as consideration for therapy has been relaxed. Additionally, the NCCN has updated the language regarding DEXA scanning for osteopenia/osteoporosis by removing the language indicating a prior diagnosis of osteoporosis/osteopenia was required for DEXA scanning.
American Heart Association (AHA) and American College of Cardiology (ACC)
The 2025 AHA/ACC Scientific Statement on competitive sports participation for athletes with cardiovascular abnormalities shifts from a paternalistic restriction model to a shared decision-making (SDM) approach, emphasizing individualized risk assessment.
Key updates include:
- removal of universal sports disqualifications, particularly for genetic cardiomyopathies like HCM and ARVC, with data supporting lower-than-expected risks;
- a more nuanced classification of sports based on endurance, strength, and collision risks rather than rigid categories;
- incorporation of new data on myocarditis, allowing return to play sooner than the traditional 3-month restriction if cardiac inflammation resolves;
- expanded inclusion of masters athletes (≥35 years old), given increased coronary artery disease risks; and
- greater focus on race-related disparities in ECG interpretation and access to care.
Alzheimer’s Association
The Alzheimer’s Association recently published guidelines on the diagnosis, evaluation, and disclosure of Alzheimer disease (AD) and related dementias (ADRD) in primary care and general clinical practice settings, addressing prior gaps in standardized evaluation outside of specialty care. The guidelines emphasize patient-centered communication and a triadic clinician–patient–care partner model to improve disclosure and care planning. Integration of validated cognitive assessments and routine use of biomarker-supported diagnostics, including CSF and PET imaging, are recommended when standard evaluations yield uncertainty. The association also discusses a new risk-stratified diagnostic framework, shifting away from a binary diagnosis toward a probabilistic, syndrome-based approach. They have also enhanced recommendations for evaluating cognitive impairment in diverse populations.
The American Thoracic Society (ATS), U.S. Centers for Disease Control and Prevention (CDC), European Respiratory Society (ERS), and Infectious Diseases Society of America (IDSA)
The updated ATS/CDC/ERS/IDSA guidelines for tuberculosis (TB) treatment emphasize shorter and all-oral regimens for drug-susceptible and drug-resistant TB. For drug-susceptible pulmonary TB, a novel 4-month regimen with isoniazid, rifapentine, pyrazinamide, and moxifloxacin is conditionally recommended for patients aged 12 and older, offering an alternative to the standard 6-month regimen. Children and adolescents (ages 3 months to 16 years) with nonsevere TB can now be treated with a 4-month regimen instead of 6 months. For drug-resistant TB, new recommendations support the use of 6-month all-oral regimens containing bedaquiline, pretomanid, and linezolid (BPaL) or with the addition of moxifloxacin (BPaLM) as alternatives to conventional 15-month regimens.
American Society of Clinical Oncology (ASCO)
The 2025 ASCO guideline update on neoadjuvant chemotherapy (NACT) for newly diagnosed advanced ovarian cancer reinforces patient selection criteria and treatment sequencing to optimize outcomes.
Recommendations include:
- refined selection criteria for NACT, recommending it for patients with high perioperative risk or low likelihood of complete cytoreduction, while primary cytoreductive surgery (PCS) remains preferred for fit patients with resectable disease;
- histologic confirmation of invasive ovarian cancer before initiating NACT, with core biopsies preferred over cytology alone;
- NACT regimen recommendations, with platinum-taxane doublet therapy remaining standard, and bevacizumab considered in select cases;
- revised recommendations on interval cytoreductive surgery (ICS), emphasizing surgery after ≤4 NACT cycles in responsive or stable disease;
- consideration of hyperthermic intraperitoneal chemotherapy (HIPEC) during ICS for stage III, good performance status patients; and
- genetic and molecular testing at diagnosis to inform treatment, including FDA-approved maintenance therapies post-NACT.
BMJ Rapid Recommendations
The international expert panel of BMJ Rapid Recommendations strongly recommend against spine injections or joint radiofrequency ablation for non-cancer chronic back pain since such interventions provide little to no pain relief as compared with sham injections.
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Jerm Day-Storms, PhD, MWC
Contact me: jerm@day-storms.com | (863) 279-7910
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