scholarly journals Prostate Cancer, Version 2.2019, NCCN Clinical Practice Guidelines in Oncology

2019 ◽  
Vol 17 (5) ◽  
pp. 479-505 ◽  
Author(s):  
James L. Mohler ◽  
Emmanuel S. Antonarakis ◽  
Andrew J. Armstrong ◽  
Anthony V. D’Amico ◽  
Brian J. Davis ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Clinical Practice ◽  
Genetic Testing ◽  
Risk Stratification ◽  
Hormonal Therapy ◽  
Advanced Disease ◽  
Treatment Options ◽  
Molecular Testing ◽  
Nccn Guidelines ◽  
Localized Disease

The NCCN Guidelines for Prostate Cancer include recommendations regarding diagnosis, risk stratification and workup, treatment options for localized disease, and management of recurrent and advanced disease for clinicians who treat patients with prostate cancer. The portions of the guidelines included herein focus on the roles of germline and somatic genetic testing, risk stratification with nomograms and tumor multigene molecular testing, androgen deprivation therapy, secondary hormonal therapy, chemotherapy, and immunotherapy in patients with prostate cancer.

Inadequacies in genetic testing referrals and counseling in prostate cancer.

2020 ◽  
Vol 38 (29_suppl) ◽  
pp. 43-43
Author(s):  
Yash Suri ◽  
Lakshminarayanan Nandagopal ◽  
Arnab Basu
Keyword(s):  
Prostate Cancer ◽  
Genetic Testing ◽  
Cancer Patients ◽  
Metastatic Disease ◽  
Flow Diagram ◽  
Nccn Guidelines ◽  
High Prevalence ◽  
Survey Results ◽  
Localized Disease ◽  
Clinic Visits

43 Background: Recent studies have recognized the high prevalence of germline mutations in genes affecting DNA repair in patients with prostate cancer. In recognition of their growing clinical significance, the NCCN guidelines recommend genetic counselling in prostate cancer pts with certain risk factors. The application of these guidelines in clinical practice were evaluated. Methods: All new clinic visits of prostate cancer pts at UAB from January 2019 – June 2019 were identified and analyzed. We constructed a flow diagram of the UAB two-step referral model, and performed a chart review and analyzed the new clinic visits. We then sent a 10-item questionnaire to providers at UAB to collect information on germline genetic testing patterns, general approach to testing, and the barriers of GC, and actions to overcome barriers. Results: From January to June 2019, 57 new prostate cancer patients were seen, of which 23 had metastatic disease, 20 had high or intermediate risk localized disease and remaining had biochemical recurrence. In total, 38 had an indication for GC. The most common indication was metastatic disease in 23 pts (40%) and localized high risk in 15 pts (26%). Significantly 33% of 24 patients with early onset prostate cancer < 60 yrs did not meet NCCN defined criteria for testing. Only 39% of the 38 eligible patients were referred, with testing completed in 11% of those with indications. The response rate to the survey was 91%. 30% of respondents reported that they would be comfortable completing genetic counseling themselves, and the most commonly reported barrier to providing the testing themselves was time, and lack of expertise/experience. 70% percent of providers cited that lack of genetics workforce was a barrier to genetic testing, and 60% cited lack of knowledge of genetic testing and genetics and the inadequate coordination of referrals were barriers. Conclusions: While a majority of prostate cancer patients seen in the oncology clinic meet criteria for GC, referrals are inconsistent, and only a handful of eligible patients complete testing. From the survey results, the areas that need to be improved from the provider’s side are education and comfort with genetic testing. From a systems perspective, the need for more genetics workforce, and better process workflows are required to improve the uptake of Genetic Testing Referral and Testing. The interventions of practice transformation and education need to be implemented, and tested at UAB to improve adherence to the NCCN guidelines for genetic testing of prostate cancer.

Molecular genetic testing patterns for patients with newly diagnosed acute myeloid leukemia (AML) enrolled in the CONNECT MDS/AML disease registry.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 7022-7022 ◽  
Author(s):  
Daniel Aaron Pollyea ◽  
Tracy George ◽  
Kathryn M Foucar ◽  
Harry Paul Erba ◽  
Michael A. Thompson ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Genetic Testing ◽  
Molecular Genetic ◽  
Molecular Testing ◽  
Newly Diagnosed ◽  
Molecular Genetic Testing ◽  
Disease Registry ◽  
Nccn Guidelines ◽  
Recurrent Mutations ◽  
Testing Patterns

7022 Background: Recurrent mutations in AML-associated genes have prognostic value and may help guide treatment decisions. Molecular genetic testing patterns for AML in clinical practice are largely unknown. Previously the CONNECT MDS/AML Disease Registry (George et al. ASH 2016. Abstract 3548) showed suboptimal adherence to WHO 2008 recommendations for AML in a cohort of newly diagnosed (ND) AML patients (pts) in clinical practice. Here we report a detailed analysis of patterns of molecular genetic testing in pts with ND AML in community and academic settings. Methods: The CONNECT MDS/AML Disease Registry (NCT01688011) is a US prospective, observational cohort study of pts with ND AML (≥55 years) or MDS. Enrollment is ongoing. All clinical decisions are made by study clinicians. The current analysis evaluated the percentage of pts with AML with molecular genetic testing recommended by NCCN guidelines ( NPM1, FLT3-ITD, CEBPA, IDH1, IDH2, DNMT3A, and KIT). Chi-square tests evaluated effects of several variables on likelihood of molecular genetic testing. Results: Between 12 Dec 2013, and 8 Dec 2016 (data cutoff), 259 AML pts were enrolled at 86 sites. Molecular genetic testing was reported in 67% (173/259) of pts. Likelihood of testing varied, respectively, for academic vs community sites (76% [70/92] vs 62% [103/167], P= .018), normal vs abnormal karyotype (77% [79/103] vs 59% [79/133], P= .006), age < 65 vs ≥65 (83% [65/78] vs 60% [108/181], P= .0003), and Medicare vs other insurance (61% [83/137] vs 74% [90/122], P= .025). In pts with molecular genetic testing (n = 173), the mutations tested varied substantially. All of the NCCN-recommended molecular genetic tests were reported in 9% (15/173) of pts, including 8% (6/79) of those with normal karyotype. Of the 7 NCCN-recommended tests, NPM1 (77%) and FLT3-ITD (76%) were most often reported and DNM T3A least often (16%). Conclusions: Early data from the CONNECT MDS/AML Disease Registry reveal that despite molecular testing reported in 67% of ND AML pts, a majority do not receive guideline-recommended testing. This prospective registry is uniquely positioned to capture changes in testing patterns as guidelines are established.

scholarly journals The Management of Older Adults with Pancreatic Adenocarcinoma

Geriatrics ◽  
2018 ◽  
Vol 3 (4) ◽  
pp. 85 ◽  
Author(s):  
John Ogden ◽  
Hao Xie ◽  
Wen Ma ◽  
Joleen Hubbard
Keyword(s):  
Older Adults ◽  
Pancreatic Cancer ◽  
Clinical Trial ◽  
Treatment Options ◽  
Karnofsky Performance Score ◽  
Nccn Guidelines ◽  
The Us ◽  
Localized Disease ◽  
Clinical Trial Enrollment ◽  
Current Guidelines

Pancreatic cancer is the eleventh most common cancer, yet it is the third leading cause of mortality. It is also largely a disease of older adults, with the median age of 71 at diagnosis in the US, with <1% of diagnoses occurring prior to age 50. Current NCCN guidelines recommend surgery for localized disease, followed by adjuvant therapy and/or consideration of enrollment in a clinical trial. For metastatic disease, current guidelines recommend clinical trial enrollment or systemic chemotherapy based on results from the landmark ACCORD-11 and MPACT trials. However, these trials focused heavily on younger, more fit patients, with the ACCORD-11 trial excluding patients over age 75 and the MPACT trial having 92% of its patients with a Karnofsky performance score >80. This article summarizes the available evidence in current literature in regards to the best treatment options for older adults, who represent the majority of pancreatic cancer diagnoses.

scholarly journals NCCN Guidelines® Insights: Melanoma: Cutaneous, Version 2.2021

2021 ◽  
Vol 19 (4) ◽  
pp. 364-376
Author(s):  
Susan M. Swetter ◽  
John A. Thompson ◽  
Mark R. Albertini ◽  
Christopher A. Barker ◽  
Joel Baumgartner ◽  
...  
Keyword(s):  
Lymph Node ◽  
Systemic Therapy ◽  
Advanced Disease ◽  
Primary Melanoma ◽  
Lymph Node Biopsy ◽  
Molecular Testing ◽  
Nccn Guidelines ◽  
Therapeutic Lymph Node Dissection ◽  
The Past ◽  
Node Biopsy

Over the past few years, the NCCN Guidelines for Melanoma: Cutaneous have been expanded to include pathways for treatment of microscopic satellitosis (added in v2.2020), and the following Principles sections: Molecular Testing (added in v2.2019), Systemic Therapy Considerations (added in v2.2020), and Brain Metastases Management (added in v3.2020). The v1.2021 update included additional modifications of these sections and notable revisions to Principles of: Pathology, Surgical Margins for Wide Excision of Primary Melanoma, Sentinel Lymph Node Biopsy, Completion/Therapeutic Lymph Node Dissection, and Radiation Therapy. These NCCN Guidelines Insights discuss the important changes to pathology and surgery recommendations, as well as additions to systemic therapy options for patients with advanced disease.

Need for re-evaluation of current guidelines based on results from germline genetic testing in prostate cancer.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 5009-5009 ◽  
Author(s):  
Piper L.W. Nicolosi ◽  
Scott T. Michalski ◽  
Brandy Freschi ◽  
Erin O'Leary ◽  
Rita Quintana ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Dna Repair ◽  
Genetic Testing ◽  
Genetic Screening ◽  
Screening Methods ◽  
Germline Variants ◽  
Nccn Guidelines ◽  
Dna Repair Gene ◽  
Current Guidelines ◽  
Positive Results

5009 Background: Inherited risk for prostate cancer (PCa) is potentially associated with more aggressive disease. Recent data indicate that DNA repair gene abnormalities may be much more common than previously appreciated, especially BRCA2, ATM, CHEK2, BRCA1, RAD51D, and PALB2. Herein, we investigate the efficacy of a targeted gene panel in men with PCa and evaluate clinical factors in relationship to current guidelines for genetic screening. Methods: DNA sequencing and exon-level copy number analysis were performed in 1158 PCa patients (pts) between 2013 and 2016 at a commercial diagnostic laboratory. The genes requisitioned varied but consistently included 14 genes on a hereditary PCa panel, most of which were DNA repair genes. Evaluation included Gleason scores and eligibility for genetic screening based on any NCCN testing criteria in pts with positive findings (pathogenic, likely pathogenic, and risk allele). Results: Pathogenic findings were identified in 199 of 1158 (17.2%) pts, 13 pts (1.0%) had two variants. Roughly 75% of detected variants were in genes on the hereditary PCa panel, of which 34.4% were BRCA1/2. Positive variants in HOXB13, a gene associated only with PCa risk, were identified in eight (3.8%) pts. DNA mismatch repair variants, alterations with substantial known therapeutic implications, were detected in 1.7% of samples. A total of 12.4% of pts with Gleason scores of ≤6, compared with 15.4% of those with scores of ≥7 had a pathogenic variant. Within this cohort, 126 (63%) patients with positive results were eligible for genetic testing based on currently available NCCN guidelines, whereas 73 (37%) would not have qualified. Conclusions: Current NCCN guidelines and Gleason scores cannot be used to reliably stratify PCa pts for the presence/absence of pathogenic germline variants. Most positive results identified in this study have important management implications for pts and their families. The percentage of pts with germline variants who did not meet current genetic screening criteria underscores the need for revisiting current guidelines which cannot, at this time, reliably be used to predict pathologic findings on genetic testing.

scholarly journals The Age Threshold of the 8th Edition AJCC Classification Is Useful for Indicating Patients with Aggressive Papillary Thyroid Cancer in Clinical Practice. 

2020 ◽  
Author(s):  
Krzysztof Kaliszewski ◽  
Dorota Diakowska ◽  
Łukasz Nowak ◽  
Beata Wojtczak ◽  
Jerzy Rudnicki
Keyword(s):  
Thyroid Cancer ◽  
Clinical Practice ◽  
Risk Stratification ◽  
Papillary Thyroid Cancer ◽  
Advanced Disease ◽  
Locally Advanced ◽  
Papillary Thyroid ◽  
Locally Advanced Disease ◽  
In Series ◽  
8Th Edition

Abstract Background: Papillary thyroid cancer (PTC) is unique among cancers in that patient age is a consideration in staging. One of the most important modifications in the 8th Edition of the American Joint Committee on Cancer (AJCC) classification is to increase the age cut off for risk stratification in PTC from 45 to 55 years. However, whether this cut off is useful in clinical practice remains controversial. In the present study, we assessed how well this new age threshold stratifies patients with aggressive PTC.Methods: We retrospectively analyzed the clinicopathological features and overall survival rate of patients with PTC admitted to and surgically treated at a single surgical center. The study protocol was divided into two series. In each series all patients (n=523) were divided in 2 groups according to age cut off. In the first series (cut off 45) patients <45 (n=193) vs. ≥45 (n=330) were compared, and in the second series (cut off 55) patients <55 (n=306) vs. ≥55 (n=217) were compared.Results: The rate of the prevalence of locally advanced disease (pT3 and pT4) was significantly higher in the patients above 55 years old than in those below 55 years old (p=0.013). No significant differences were found for this parameter in series with cut off point 45 years old. A significantly higher risk of locally advanced disease T3+T4 (OR=4.87) and presence of LNM (N1) (OR=3.78) was observed in ≥45 years old group (p=0.021 and p<0.0001, respectively). More expressive results were found for the patients ≥55 years old group, where the risk of locally advanced disease (T3+T4) was higher (OR=5.21) and LNM presence was OR=4.76 (p<0.001 and p<0.0001, respectively). None of the patients below 55 years old showed distant metastasis, but 19 patients above 55 years old showed M1 (p<0.0001). In older patients group (≥55 years old) we observed deaths related thyroid cancer in 11 individuals.Conclusions: The age cut off of 55 years old for risk stratification proposed by the 8th Edition of AJCC effectively stratifies PTC patients with a poor prognosis, indicating it is likely to be useful in clinical practice.

scholarly journals The Age Threshold of the 8th Edition AJCC Classification Is Useful for Indicating Patients with Aggressive Papillary Thyroid Cancer in Clinical Practice. 

2020 ◽  
Author(s):  
Krzysztof Kaliszewski ◽  
Dorota Diakowska ◽  
Łukasz Nowak ◽  
Beata Wojtczak ◽  
Jerzy Rudnicki
Keyword(s):  
Thyroid Cancer ◽  
Clinical Practice ◽  
Risk Stratification ◽  
Papillary Thyroid Cancer ◽  
Advanced Disease ◽  
Locally Advanced ◽  
Papillary Thyroid ◽  
Locally Advanced Disease ◽  
In Series ◽  
8Th Edition

Abstract Background: Papillary thyroid cancer (PTC) is unique among cancers in that patient age is a consideration in staging. One of the most important modifications in the 8th Edition of the American Joint Committee on Cancer (AJCC) classification is to increase the age cut off for risk stratification in PTC from 45 to 55 years. However, whether this cut off is useful in clinical practice remains controversial. In the present study, we assessed how well this new age threshold stratifies patients with aggressive PTC.Methods: We retrospectively analyzed the clinicopathological features and overall survival rate of patients with PTC admitted to and surgically treated at a single surgical center. The study protocol was divided into two series. In each series all patients (n=523) were divided in 2 groups according to age cut off. In the first series (cut off 45) patients <45 (n=193) vs. ≥45 (n=330) were compared, and in the second series (cut off 55) patients <55 (n=306) vs. ≥55 (n=217) were compared.Results: The rate of the prevalence of locally advanced disease (pT3 and pT4) was significantly higher in the patients above 55 years old than in those below 55 years old (p=0.013). No significant differences were found for this parameter in series with cut off point 45 years old. A significantly higher risk of locally advanced disease T3+T4 (OR=4.87) and presence of LNM (N1) (OR=3.78) was observed in ≥45 years old group (p=0.021 and p<0.0001, respectively). More expressive results were found for the patients ≥55 years old group, where the risk of locally advanced disease (T3+T4) was higher (OR=5.21) and LNM presence was OR=4.76 (p<0.001 and p<0.0001, respectively). None of the patients below 55 years old showed distant metastasis, but 19 patients above 55 years old showed M1 (p<0.0001). In older patients group (≥55 years old) we observed deaths related thyroid cancer in 11 individuals.Conclusions: The age cut off of 55 years old for risk stratification proposed by the 8th Edition of AJCC effectively stratifies PTC patients with a poor prognosis, indicating it is likely to be useful in clinical practice.

scholarly journals The Age Threshold of the 8th Edition AJCC ClassificationIs Useful for Indicating Patients with Aggressive Papillary Thyroid Cancer in Clinical Practice.

2020 ◽  
Author(s):  
Krzysztof Kaliszewski ◽  
Dorota Diakowska ◽  
Łukasz Nowak ◽  
Beata Wojtczak ◽  
Jerzy Rudnicki
Keyword(s):  
Thyroid Cancer ◽  
Clinical Practice ◽  
Risk Stratification ◽  
Papillary Thyroid Cancer ◽  
Advanced Disease ◽  
Locally Advanced ◽  
Papillary Thyroid ◽  
Locally Advanced Disease ◽  
In Series ◽  
8Th Edition

Abstract Background: Papillary thyroid cancer (PTC) is unique among cancers in that patient age is a consideration in staging. One of the most important modifications in the 8th Edition of the American Joint Committee on Cancer (AJCC) classificationis to increase the age cutoff for risk stratification in PTC from 45 to 55 years. However, whether this cutoff is useful in clinical practice remains controversial. In the present study, we assessed how well this new age threshold stratifies patients with aggressive PTC.Methods: We retrospectively analyzed the clinicopathological features and overall survival rate of patients with PTC admitted to and surgically treated at a single surgical center. The study protocol was divided into two series. In each series all patients (n=523) were divided in 2 groups according to age cutoff. In the first series (cutoff 45) patients <45 (n=193) vs. ≥45 (n=330) were compared, and in the second series (cutoff 55) patients <55 (n=306) vs. ≥55 (n=217) were compared.Results: The rate of the prevalence of locally advanced disease (pT3 and pT4) was significantly higher in the patients above 55 years old than in those below 55 years old (p=0.013). No significant differences were found for this parameter in series with cutoff point 45 years old. A significantly higher risk of locally advanced disease T3+T4 (OR=4.87) and presence of LNM (N1) (OR=3.78) was observed in ≥45 years old group (p=0.021 and p<0.0001, respectively). More expressive results were found for the patients ≥55 years old group, where the risk of locally advanced disease (T3+T4) was higher (OR=5.21) and LNM presence was OR=4.76 (p<0.001 and p<0.0001, respectively). None of the patients below 55 years old showed distant metastasis, but 19 patients above 55 years old showed M1 (p<0.0001). In older patients group (≥55 years old) we observed deaths related thyroid cancer in 11 individuals.Conclusions: The age cut off of 55 years old for risk stratification proposed by the 8th Edition of AJCC effectively stratifies PTC patients with a poor prognosis, indicating it is likely to be useful in clinical practice.

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