Patients with cancer are at high risk of developing arterial and venous thromboembolism (VTE). They constitute 15% to 20% of the patients diagnosed with VTE. Depending on the type of tumor, cancer therapy, and presence of other risk factors, 1% to 25% of patients with cancer will develop thrombosis. The decision to start patients with cancer on primary thromboprophylaxis depends on patient preference, balancing risk of bleeding versus risk of thrombosis, cost, and adequate organ function. Currently, guidelines recommend against the use of routine primary thromboprophylaxis in unselected ambulatory patients with cancer. Validated risk assessment models can accurately identify patients at highest risk for cancer-associated thrombosis (CAT). This review summarizes the recently updated NCCN Guidelines for CAT primary prophylaxis, with a primarily focus on VTE prevention. Two main clinical questions that providers commonly encounter will also be addressed: which patients with cancer should receive primary thromboprophylaxis (both surgical and medical oncology patients) and how to safely choose between different anticoagulation agents.
Amro Elshoury, Jordan K. Schaefer, Ming Y. Lim, Deidre P. Skalla, and Michael B. Streiff
Presenter: Nancy L. Keating
In older adult cancer survivors, cancer screening and surveillance testing carry benefits and harms that depend on a variety of factors. Benefits of screening include early diagnosis and a lower risk of death from cancer. Harms include false-positive results, unnecessary biopsies, incidental findings, and overdiagnosis. The primary factor in deciding whether older adult cancer survivors should undergo screening or surveillance testing is life expectancy, but other factors also come into play, such as a patient’s health status, goals, and values. An individualized approach as well as shared decision-making are crucial when working with patients to make these important decisions.
Presenters: Lucy R. Langer, Amye J. Tevaarwerk, and Robin Zon
Moderator : Travis Osterman
The COVID-19 pandemic has led to a massive surge in the use of telemedicine services in oncology. However, although telemedicine usage is not as high as it was early in the pandemic, it is not as low as it was before the pandemic, either, indicating that patients have a desire to receive care when, where, and how they want. Most oncology providers agree that telemedicine is beneficial and here to stay, but barriers hinder equitable delivery, such as racial/ethnic affiliations, older age, residing in a rural area, and lower socioeconomic status. The momentum created by the pandemic can serve to show the benefits of telemedicine and solidify its place in oncology care. However, addressing these disparities—and increasing widespread access to broadband and educating both patients and providers on how to use these technologies—is paramount.
Presenters: Rajiv Agarwal and Lea K. Matsuoka
Moderator : Daniel B. Brown
Liver transplant and resection are preferable for the management of hepatocellular carcinoma, but ultimately, tumor location, biology, and patient condition dictate treatment decisions. At the NCCN 2022 Annual Conference, a panel of experts used 3 case studies to develop an evidence-based approach to the treatment of similar patients with hepatocellular carcinoma. Moderated by Daniel B. Brown, MD, FSIR, the session focused on current research regarding liver-directed and systemic therapy options.
Presenters: Meena S. Moran and A. Marilyn Leitch
The latest version of NCCN Guidelines for Breast Cancer on locoregional management of early-stage breast cancer contains numerous updated recommendations, particularly focusing on management of the axilla, locoregional management after neoadjuvant therapy, and radiation delivery. Recommendations for axillary staging have been separated for patients who have undergone breast-conserving surgery and those who have had a mastectomy, creating 2 individual pathways. The section on locoregional treatment after neoadjuvant therapy has been reformatted; optimal management of this patient group continues to evolve. Lastly, specifics regarding the delivery and sequencing of radiotherapy have been updated.
Presenter: Genevieve Boland
For treatment of melanoma, accumulated research has allowed the transition of the most effective treatments into earlier stages of disease management. To this end, immunotherapy has become approved for high-risk stage II and resected stage III melanoma, and is currently being evaluated in the neoadjuvant setting. BRAF/MEK-targeted therapy is also approved in the adjuvant setting and is being evaluated in neoadjuvant trials. In stage IV disease, the optimal sequencing of these 2 main approaches is with immunotherapy initiated first. Recently, the LAG-3 antibody relatlimab, in combination with nivolumab, has produced impressive responses with low toxicity and has become a new standard of care compared with anti–PD-1 monotherapy. As heterogeneity within disease stages has become better appreciated, staging and risk classification have been refined.
Presenters: Valencia D. Thomas, Michael K. Wong, and Andrew J. Bishop
Nonmelanoma skin cancers (NMSCs), which encompass a variety of cutaneous malignancies, are frequently managed with surgery, radiation therapy, cytotoxic chemotherapy, systemic immunotherapy, and active surveillance. In this tumor board–style forum, a panel of experts used several case studies as a basis to review these approaches and to describe existing clinical challenges. The current NCCN Guidelines for NMSC, which reflect the most up-to-date, evidence-based data relating to the evaluation and management of NMSCs, also provide key considerations and recommendations for the treatment of this patient population.
Presenter: Julio M. Pow-Sang
Localized prostate cancer is a heterogeneous disease. However, some diagnostic features are helpful in categorizing patients into risk groups for adverse outcomes, such as pathology, imaging, and genetic profiling. Risk‐specific management options, including active surveillance, can be tailored to individual patients based on their risk profile. Clinicians should discuss the risks and benefits of each of these options with patients for informed decision-making.