ABSTRACT
The NCCN Guidelines for Hematopoietic Growth Factors provide recommendations for the appropriate use of growth factors in the clinical management of febrile neutropenia (FN), chemotherapy-induced thrombocytopenia (CIT), and chemotherapy-induced anemia (CIA). Management and prevention of these sequelae are an integral part of supportive care for many patients undergoing cancer treatment. The purpose of these guidelines is to operationalize the evaluation, prevention, and treatment of FN, CIT, and CIA in adult patients with nonmyeloid malignancies and to enable the patient and clinician to assess management options for FN, CIT, and CIA in the context of an individual patient's condition. These NCCN Guidelines Insights provide a summary of the important recent updates to the NCCN Guidelines for Hematopoietic Growth Factors, with particular emphasis on the incorporation of a newly developed section on CIT.
Subject(s)
Anemia , Antineoplastic Agents , Neoplasms , Adult , Anemia/chemically induced , Anemia/drug therapy , Antineoplastic Agents/adverse effects , Hematopoietic Cell Growth Factors/therapeutic use , Humans , Neoplasms/drug therapyABSTRACT
Management of febrile neutropenia (FN) is an integral part of supportive care for patients undergoing cancer treatment. The NCCN Guidelines for Hematopoietic Growth Factors provide suggestions for appropriate evaluation, risk determination, prophylaxis, and management of FN. These NCCN Guidelines are intended to guide clinicians in the appropriate use of growth factors for select patients undergoing treatment of nonmyeloid malignancies. These NCCN Guidelines Insights highlight important updates to the NCCN Guidelines regarding the incorporation of newly FDA-approved granulocyte-colony stimulating factor biosimilars for the prevention and treatment of FN.
Subject(s)
Biosimilar Pharmaceuticals/therapeutic use , Chemotherapy-Induced Febrile Neutropenia/drug therapy , Hematopoietic Cell Growth Factors/therapeutic use , Neoplasms/drug therapy , Practice Guidelines as Topic , Antineoplastic Combined Chemotherapy Protocols/adverse effects , Biosimilar Pharmaceuticals/economics , Biosimilar Pharmaceuticals/standards , Chemotherapy-Induced Febrile Neutropenia/etiology , Drug Approval , Drug Costs , Education, Medical, Continuing , Hematopoietic Cell Growth Factors/economics , Hematopoietic Cell Growth Factors/standards , Humans , Medical Oncology/education , Medical Oncology/standards , Neoplasms/blood , Oncologists/education , Organizations, Nonprofit/standards , Risk Factors , United States , United States Food and Drug Administration/legislation & jurisprudenceABSTRACT
The NCCN Guidelines for Neuroendocrine and Adrenal Tumors provide recommendations for the management of adult patients with neuroendocrine tumors (NETs), adrenal gland tumors, pheochromocytomas, and paragangliomas. Management of NETs relies heavily on the site of the primary NET. These NCCN Guidelines Insights summarize the management options and the 2018 updates to the guidelines for locoregional advanced disease, and/or distant metastasis originating from gastrointestinal tract, bronchopulmonary, and thymus primary NETs.
Subject(s)
Adrenal Gland Neoplasms/therapy , Delivery of Health Care, Integrated/standards , Medical Oncology/standards , Neuroendocrine Tumors/therapy , Adrenal Gland Neoplasms/diagnosis , Adult , Humans , Neuroendocrine Tumors/diagnosis , Societies, Medical/standards , United StatesABSTRACT
Metastatic primary cutaneous extramammary Paget disease (EMPD) is a rare clinical entity with a 5-year survival <10% and no standard therapy. We report the first case to our knowledge of metastatic EMPD with treatment response to checkpoint inhibitor immunotherapy. The patient had diffusely metastatic disease and previously progressed on cytotoxic chemotherapy and a molecularly targeted agent. Treatment with four cycles of ipilimumab 1 mg/kg plus nivolumab 3 mg/kg resulted in a durable partial response lasting 7 months. Analysis of metastatic tumor tissue failed to identify known predictors of treatment response to immune checkpoint inhibitors, such as high PD-L1 expression, high tumor mutation burden, or microsatellite instability. These findings support further investigation of immune checkpoint inhibition for the management of metastatic EMPD, which currently has an abysmal prognosis and no standard therapies.