scholarly journals Real-World Adherence to National Comprehensive Cancer Network (NCCN) Guidelines Regarding the Usage of PET/CT and Reported Deauville Scores in Advanced Stage Classical Hodgkin Lymphoma: A Community Oncology Practice Perspective

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 32-33
Author(s):  
Christopher A. Yasenchak ◽  
Jamyia Clark ◽  
Nicholas Liu ◽  
April Beeks ◽  
Michelle A. Fanale ◽  
...  
Keyword(s):  
National Comprehensive Cancer Network ◽  
Stage Iii ◽  
Classical Hodgkin Lymphoma ◽  
Publicly Traded ◽  
Nccn Guidelines ◽  
Interim Pet ◽  
Deauville Score ◽  
Community Oncology ◽  
Pet Ct ◽  
Cancer Network

Introduction: Current National Comprehensive Cancer Network (NCCN) guidelines recommend one of three frontline (1L) regimens to treat stage III or IV classical Hodgkin Lymphoma (cHL): doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD), brentuximab vedotin, doxorubicin, vinblastine, and dacarbazine (A+AVD), or bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone (escalated (e) dose-BEACOPP). PET/CT imaging is important at initial staging and in follow up including after two cycles (interim PET2) to assess and adapt treatment based on response for patients who newly start treatment with ABVD (Johnson et al., 2016). Despite NCCN guidelines, physicians in community oncology practices may face challenges optimizing outcomes for ABVD patients utilizing the interim PET2 adaptive approach. This study evaluated interim PET2 utilization and reported Deauville scores (DS) in patients with stage III or IV cHL treated in the 1L setting. Methods: This retrospective observational study included adult patients diagnosed with stage III or IV cHL and treated with 1L ABVD, A+AVD, or eBEACOPP within the US Oncology Network (USON) between 01 January 2017 and 31 January 2020. Patients enrolled in therapeutic clinical trials or received treatment for another primary cancer diagnosis were excluded. Patient data were sourced from the USON's electronic health records database, iKM™. Demographic, clinical, and treatment characteristics were sourced from structured iKM elements. Interim PET2 details, including Deauville scores, were obtained from manual chart review. Descriptive statistics were generated for all patient characteristics. Results: 262 patients with cHL were eligible. The majority of the patients were <39 years (48.9%), male (56.9%), Caucasian (58.8%), stage IV cHL (50.8%), had a low (<4) International Prognostic Score (76.0%), completed most treatment cycles (median = 6 [IQR 2,4]) and were treated with 1L ABVD (74.0%). Almost all patients (98.5%) had at least one documented PET-CT of which 87.6% had one at baseline (≤90 days prior to treatment initiation) and 79% had an interim PET-CT (Figure). For patients treated with 1L ABVD with an interim PET-CT, 65% did not report a Deauville score vs. 35% with a documented Deauville score (of which, 29% with score of 1-3 and 5.0% with score of 4-5). 54% of patients treated with 1L A+AVD did not report a Deauville score compared to 42% with scores of 1-3 and 4% with scores of 4-5. The majority of patients (93%) treated with 1L ABVD with or without a reported Deauville score de-escalated to AVD. Results were consistent in the sensitivity analysis of patients with both baseline PET-CT and interim PET-CT. Conclusions: Findings from this retrospective, observational, community oncology study found that Deauville scores were reported for only 1/3 of interim PET-CT in patients treated with 1L ABVD patients with stage III or IV cHL. Despite this, initial treatment modification of de-escalation from ABVD to AVD was common and escalation to BEACOPP was rarely observed. These results suggest that albeit interim PET-CT is utilized, the Deauville scores to inform escalation or de-escalation of treatment decisions in stage III or IV cHL patients is missing and not universally reported in the community oncology setting. Our findings support a potential opportunity to educate oncologists and radiologists on the importance of consistently reporting PET-CT Deauville scores given the fact that providers may lack the complete information to ensure treatment modifications are optimized for patient outcomes. Additionally, compared with ABVD, A+AVD that does not require treatment adaptation by interim PET/CT Deauville score may be a therapy option. Figure 1 Disclosures Yasenchak: BeiGene: Speakers Bureau; Seattle Genetics: Honoraria, Research Funding; Takeda: Honoraria. Clark:McKesson Life Sciences: Current Employment, Current equity holder in publicly-traded company. Liu:Seattle Genetics: Current Employment, Current equity holder in publicly-traded company. Beeks:F. Hoffmann-La Roche Ltd: Consultancy; McKesson: Current Employment. Fanale:Seattle Genetics: Current Employment, Current equity holder in publicly-traded company. Robert:McKesson: Current Employment. Yu-Isenberg:Seattle Genetics: Current Employment, Current equity holder in publicly-traded company.

scholarly journals Classical Hodgkin Lymphoma; Real-World Observations from Physicians, Patients, and Caregivers on the Disease and Its Treatment (CONNECT): Observations of Physicians on Treatment and Interim PET-Adapted Regimens

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 1390-1390
Author(s):  
Susan K. Parsons ◽  
Kristina S. Yu ◽  
Nicholas Liu ◽  
Supriya Kumar ◽  
Michelle A. Fanale ◽  
...  
Keyword(s):  
Ct Scan ◽  
Stage Iii ◽  
Ct Scans ◽  
Classical Hodgkin Lymphoma ◽  
Publicly Traded ◽  
Nccn Guidelines ◽  
Interim Pet ◽  
Deauville Score ◽  
Pet Ct ◽  
Pet Ct Scan

Abstract Background Current NCCN guidelines recommend 1 of 3 first-line (1L) regimens for stage III or IV classical Hodgkin lymphoma (cHL): ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine), A+AVD (brentuximab vedotin, doxorubicin, vinblastine, dacarbazine), or escalated BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, prednisone); preferred regimens vary by region (e.g., North America vs Europe). The NCCN recommends positron emission tomography/computerized tomography (PET/CT) imaging after cycle 2 (interim PET2) to guide ABVD escalation or de-escalation. We surveyed physicians on their cHL treatment decision-making process and how PET/CT scan access, reimbursement, and comprehension influence their choices as part of CONNECT, the first real-world survey of physicians, patients, and caregivers in cHL. Methods Medical oncologists, hematologist/oncologists, or hematologists who treat cHL were invited to participate in an Institutional Review Board-approved, 30-minute online anonymous survey. Eligible participants had ≥2 years of practice experience in the United States (US) and treated ≥1 adult (aged ≥18 years) with stage III or IV cHL and ≥1 adult with cHL in the 1L setting within the prior 12 months. Surveys were completed from October 19, 2020-November 16, 2020. Results Of 301 participating physicians, 80% were hematologist/oncologists with a median practice duration of 15 years; 62% practiced in community and 38% in academic settings. Participants were located in the US (South, 34%; Northeast, 26%; West, 21%; Midwest, 20%) and spent 90% of their professional time in direct patient care. In the preceding 12 months, participants treated a median (interquartile range) of 16 (7-40) patients with active cHL (stage III [median], 4; stage IV, 5) and 15 (8-40) cHL survivors. When treating cHL, 88% of participants reported giving NCCN guidelines somewhat/significant consideration. Overall, 94% of participants (n=284) reported using a PET/CT combined scan to diagnose/stage cHL, in line with current guideline recommendations. Of these participants, 97% reported typically getting an interim PET/CT scan for stage III or IV cHL with 65% typically getting the scan after cycle 2 (Figure A). Participants reported both escalating and de-escalating treatment based on interim PET/CT results (Figure B) with 61% making decisions after cycle 2. Of participants using a PET/CT scan, 42% reported receiving both a Deauville score and a standardized uptake value (SUV; Figure C) with 62% of participants noting that the Deauville score was the primary system used for reviewing PET/CT results (Figure D). However, 19% of participants reported challenges interpreting PET/CT results. Among participants using a Deauville score (n=209), consensus was limited on what defined a positive scan (≥3, 44%; ≥4, 37%). Challenges obtaining PET/CT scans were reported by 16% of participants using PET/CT scans. However, despite not reporting challenges 55% of participants on average were unable to obtain a PET/CT scan 20% of the time. Of participants using PET/CT scans, 86% reported typically receiving results within 2 business days and 14% within 3-5 business days. Twenty-one percent of participants reported that delays in PET/CT results affected their ability to use a PET-adaptive approach. Forty-nine percent of those using PET/CT scans reported increased difficulty in PET/CT access for stage III or IV cHL due to lack of insurance coverage. In absence of a PET/CT scan, 36% of participants reported using an interim biopsy and 63% an interim CT scan to inform treatment choices. Among all participants, 36% reported increased difficulty in getting patients with cHL access to PET/CT scans due to COVID-19. Conclusions Although participants consider NCCN guidelines when treating cHL, interim PET scans are not universally obtained after cycle 2 for stage III or IV cHL, with 65% of participants who use PET/CT scans obtaining an interim PET scan after cycle 2 for stage III or IV cHL. When PET/CT scans are obtained, Deauville scores are commonly provided; however, there is variability in what is termed a positive or negative Deauville score. Challenges in obtaining PET/CT scans, with increased difficulty during COVID-19, were reported. Also, there are other barriers, such as lack of insurance, that may prohibit the optimal adherence to guidelines on interim PET/CT utilization. Figure 1 Figure 1. Disclosures Parsons: SeaGen: Consultancy. Yu: Seagen, Inc: Current Employment, Current equity holder in publicly-traded company. Liu: Seagen, Inc: Current Employment, Current equity holder in publicly-traded company. Kumar: Seagen, Inc: Consultancy. Fanale: Seagen, Inc: Current Employment, Current equity holder in publicly-traded company. Flora: Seagen, Inc: Research Funding.

Level of Scientific Evidence Underlying Recommendations from the National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines for Hematologic Malignancies: Are We Moving Forward?

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 32-32
Author(s):  
Aakash Desai ◽  
Harry E Fuentes ◽  
Sri Harsha Tella ◽  
Caleb J Scheckel ◽  
Thejaswi Poonacha ◽  
...  
Keyword(s):  
Clinical Practice ◽  
National Comprehensive Cancer Network ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Scientific Evidence ◽  
Hematologic Malignancies ◽  
Level Of Evidence ◽  
Nccn Guidelines ◽  
Therapeutic Recommendations ◽  
Cancer Network

Background: National Comprehensive Cancer Network (NCCN) guidelines are the most comprehensive and widely used standard for clinical care in malignant hematology by clinicians and payers in the US. The level of scientific evidence in NCCN guidelines for malignant hematological conditions has not been recently investigated. We describe the distribution of categories of evidence and consensus (EC) among the 10 most common hematologic malignancies with regard to recommendations for staging, initial and salvage therapy, and surveillance. Methods: NCCN uses a system of guideline development distinct from other major professional organizations. The NCCN definitions for EC are: category I, high level of evidence such as randomized controlled trials with uniform consensus; category IIA, lower level of evidence with uniform consensus; category IIB, lower level of evidence without a uniform consensus but with no major disagreement; and category III, any level of evidence but with major disagreement. We compared our results with previously published results from 2011 guidelines. Results: Total recommendations increased by 16.6% from 1160 (2011) to 1353 (2020). Of the 1353 recommendations, Category 1, 2A, 2B and 3 EC were 5%, 91%, 4%, 1% while in 2011 they were 3%, 93%, 4% and 0% respectively. Recommendations with category 1 EC were found in all guidelines, except for Burkitt's Lymphoma. 6.3% of therapeutic recommendations were category 1 EC with the majority (56.4%) pertaining to initial therapy. Guidelines with highest proportions of therapeutic recommendations with category 1 EC were Multiple Myeloma (12.4%), CLL/SLL (6.9%) and AML (5.6%). Between 2011 and 2020, the proportion of category I recommendations increased significantly only in Follicular lymphoma and CLL/SLL. No category 1 EC recommendations existed in staging or surveillance. Conclusion: Recommendations issued in the 2020 NCCN guidelines are largely developed from lower levels of evidence but with uniform expert opinion. Despite the major advances in hematology in the past decade, this is largely unchanged. Our study underscores the urgent need and available opportunities to expand the current evidence base in malignant hematological disorders which forms the platform for clinical practice guidelines. Figure Disclosures No relevant conflicts of interest to declare.

The Costs of Drugs Used to Treat Myelodysplastic Syndromes Following National Comprehensive Cancer Network Guidelines

2008 ◽  
Vol 6 (9) ◽  
pp. 942-953 ◽  
Author(s):  
Peter L. Greenberg ◽  
Leon E. Cosler ◽  
Salvatore A. Ferro ◽  
Gary H. Lyman
Keyword(s):  
National Comprehensive Cancer Network ◽  
Myelodysplastic Syndromes ◽  
Iron Chelation ◽  
International Prognostic Scoring System ◽  
Limited Attention ◽  
Recombinant Erythropoietin ◽  
Nccn Guidelines ◽  
Transfusion Requirements ◽  
Average Annual Cost ◽  
Cancer Network

Guidelines for management of patients with myelodysplastic syndromes (MDS) have been generated by the National Comprehensive Cancer Network (NCCN) Myelodysplastic Syndromes Panel. Because MDS is a heterogeneous spectrum of disorders, these patients have been categorized into prognostic subgroups, predominantly using the International Prognostic Scoring System (IPSS). Several drugs have been used to treat these patients, and their selection and sequential recommended use by the panel depend on disease characteristics and responses to treatment. Recombinant erythropoietin alfa and darbepoetin alfa have been the mainstay of therapy for treating anemia associated with MDS. The FDA has recently approved several other drugs for treating MDS, including azacytidine and decitabine for all stages of disease, lenalidomide for low-risk anemic patients with del(5q) chromosomal abnormality, and deferasirox for treating iron overload. For iron chelation, deferoxamine is also used occasionally. Treatment with immunosuppressive therapy (antithymocyte globulin and cyclosporin) has been therapeutically beneficial for a subset of younger patients with MDS. Because the financial cost of these therapies are substantial and have received only limited attention, this article evaluates the costs of specific drugs and their sequential use in the lower-risk IPSS (low and intermediate-1) subgroups based on the NCCN guidelines. Results estimate an average annual cost for potentially anemia-altering drugs of $63,577 per patient, ranging from $26,000 to $95,000, depending on the specific therapies. In patients for whom the therapies fail, annual costs for iron chelation plus red blood cell transfusions are estimated to average $41,412. The economic impact of drug therapy should be weighed against the patient's potential for improvement in clinical outcomes, quality of life, and transfusion requirements.

Compliance to National Comprehensive Cancer Network guidelines in patients with newly diagnosed small cell lung cancer at a community cancer center

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 17064-17064
Author(s):  
K. R. Oettel ◽  
R. Joseph ◽  
B. George ◽  
J. Lee ◽  
M. Mathiason ◽  
...  
Keyword(s):  
Smoking Cessation ◽  
Initial Evaluation ◽  
Cancer Center ◽  
Newly Diagnosed ◽  
Limited Disease ◽  
Smoking Cessation Counseling ◽  
Nccn Guidelines ◽  
Pet Ct ◽  
Cancer Network ◽  
Pet Ct Scan

17064 Background: The National Comprehensive Cancer Network (NCCN) provides yearly updated guidelines for the management of patients diagnosed with small cell lung cancer (SCLC). Compliance to clinical guidelines may improve patient care and outcome, but this may vary among institutions. In this study, we determined the compliance of our community cancer center to the NCCN guidelines in patients with SCLC. Methods: We identified patients with newly diagnosed SCLC in 2004 and 2005 using our cancer registry database. Using the NCCN guideline for the corresponding years, we determined the compliance rate for the following phases of cancer care: initial evaluation (pathology review, imaging, smoking cessation counseling, mediastinal staging for T1-T2 limited disease), and treatment (chemotherapy, radiation). Results: There were 39 new patients with SCLC, 14 (35.9%) of which had limited stage disease. The overall compliance rates for initial evaluation and treatment were 33.3%, and 92.3%, respectively. A total of 32 deviations were identified: 21 (65.6%) for neglecting smoking cessation counseling, 7 (21.9%) for not performing recommended imaging, 3 (9.4%) for not giving recommended chemotherapy and/or radiation and 1 (3.1%) for not reviewing outside pathology. In all of the imaging and treatment deviations, there were medically appropriate reasons for doing so: 7 patients with limited disease had PET/CT scan instead of CT/bone scan (PET/CT scan now incorporated into the 2006 guidelines); 2 patients with limited disease did not receive concurrent chemoradiotherapy due to poor performance status and co-morbidity; 1 patient with extensive disease refused chemotherapy. Conclusion: Our compliance with NCCN guidelines for SCLC was poor for initial evaluation, but better for treatment. The primary reasons for this outcome were the lack of a perceived benefit in smoking cessation counseling and the use of PET/CT scanning as the initial imaging modality of choice. No significant financial relationships to disclose.

Compliance with National Comprehensive Cancer Network guidelines for antiemesis in cisplatin regimens.

2016 ◽  
Vol 34 (7_suppl) ◽  
pp. 280-280
Author(s):  
Terri P. Wolf ◽  
Dana Ann Little
Keyword(s):  
National Comprehensive Cancer Network ◽  
Medical Center ◽  
Academic Medical Center ◽  
Cancer Center ◽  
Adherence Rate ◽  
Cancer Centers ◽  
Nccn Guidelines ◽  
Guideline Compliance ◽  
Cancer Network ◽  
The Impact

280 Background: The members of a network of community cancer centers affiliated with an academic medical center report following National Comprehensive Cancer Network (NCCN) guidelines. To determine guideline compliance, cisplatin regimens were audited. Cisplatin was selected because of its wide use, high emetic potential, and the impact on QOL for patients with unmanaged nausea and vomiting.The community cancer centers affiliated with an academic medical center report following National Comprehensive Cancer Network (NCCN) guidelines for treatment plans. To determine guideline compliance rates, cisplatin regimens were audited. Cisplatin was selected because of its wide use, high emetic potential, and the impact on QOL for patients with unmanaged nausea and vomiting. Methods: Prior to a chart audit, medical oncologists were surveyed on their knowledge of NCCN antiemesis guidelines, frequency of prescribing based on guidelines, and reasons for not using guidelines. Auditors identified patient charts through billing records and reviewed cycle 1 day 1 orders of cisplatin regimens. Secondary data was collected on hydration orders and home medications for antiemesis. Results: Guideline adherence varied from 0% to 76% with overall adherence at 28%. Dexamethasone doses ranged from 2-20 mg (guideline 12 mg) as did serotonin antagonists (5HT3) ordered at higher IV doses of 24-32 mg (guideline 8-16 mg). Conclusions: Although cancer centers report following the guidelines, this study did not find consistent adherence. The cancer center with the highest adherence rate works closely with a pharmacist and has built order sets with the guidelines. One cancer center had wide variances among practitioners. The variances increase the potential for error. The cancer center with lowest adherence rate used 10 mg doses of dexamethasone because the drug is delivered in 10 mg vials. This study identified multiple systems issues impacting guideline compliance. Managing nausea and vomiting is important for patient QOL and to manage costs by decreasing hospitalizations, treatment delays, and nutritional deficits. Understanding prescribing habits relative to guidelines provides an opportunity to change practice and reduce variability.

National Comprehensive Cancer Network petitions: Submissions and outcomes.

2016 ◽  
Vol 34 (7_suppl) ◽  
pp. 248-248
Author(s):  
Laura Bobolts ◽  
Dinah Faith Huff ◽  
William J. Hrushesky ◽  
Charles Lee Bennett ◽  
Kevin Knopf ◽  
...  
Keyword(s):  
Supportive Care ◽  
National Comprehensive Cancer Network ◽  
Liposomal Doxorubicin ◽  
Scientific Literature ◽  
Nccn Guidelines ◽  
Fda Approval ◽  
Her 2 ◽  
Ret Rearrangement ◽  
Cancer Network ◽  
Japanese Ancestry

248 Background: The National Comprehensive Cancer Network (NCCN) invites petitions to its scientific panels. Most ( > 95%) are from the pharmaceutical industry lobbying to include their products in the NCCN Guidelines. Rarely, physicians request scientific scrutiny of the guidelines. We report the experience of Oncology Analytics (OA) with petition submissions and the possible impact on guidelines. Methods: From 2011-2015, OA made 7 petitions to NCCN. The content of each was tracked into subsequent NCCN Guidelines to ascertain whether any changes resulted. Results: 1) The Survivorship Panel was petitioned to add liposomal doxorubicin to the list of cardiotoxic anthracyclines: No changes were made. 2-3) The NSCLC Panel was asked in 2014 to remove the category 2A listing for trastuzumab and afatinib as HER-2 targeted drugs, and cabozantinib as a RET rearrangement target based on absence of phase I-III full text scientific literature. This was done, however, cabozantinib was reverted to 2A status late 2015 based on abstract-only data. 4) Per FDA approval, the NSCLC Panel was asked to recommend bevacizumab only in combination with carboplatin/paclitaxel for 1st line non-squamous NSCLC based on a survival advantage in ECOG 4599: No changes were made. 5) Given the FDA-approval, the Ovarian Cancer Panel was requested to add doxorubicin: This was done. 6) A 2012 Supportive Care Panel petition pointed out the absence of data supporting palonosetron as the preferred 5-HT3 antagonist with aprepitant for moderate or high emetic risk chemotherapy: No change was made upon request; however, preferred status was removed in 2015 from high emetic risk. 7) Based on a preponderance of evidence, a Supportive Care Panel petition requested re-categorization of the febrile neutropenia risk for carboplatin/paclitaxel from intermediate to low except in patients of Japanese ancestry and/or carboplatin AUC > 6: This was done. Conclusions: Majority of NCCN physician petitions came from OA, yet constituted less than 5% of all petitions submitted. NCCN does not provide direct petitioner feedback, so we cannot say for certain that our petitions led to changes in subsequent guidelines. Not all requests resulted in NCCN changes, despite level one supportive data or accentuating an absence of data.

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