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Management of Renal Cell Carcinoma

Presented by: Michael Serzan

Immune checkpoint inhibitor therapy has served as the foundation of therapy for a majority of patients with advanced renal cell carcinoma (RCC). For patients with metastatic clear cell RCC, there are several immunotherapy-based combinations that have demonstrated robust long-term outcomes. Selection of the ideal combination for each individual patient requires nuanced strategies that are highlighted in NCCN Guidelines. More recently, data have emerged showing benefit of immune checkpoint inhibitors for patients with variant histologies. Lastly, pembrolizumab has been approved in the adjuvant setting for patients with clear cell RCC who are at high risk of recurrence after nephrectomy.

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The NCCN 2024 Annual Conference

Crystal S. Denlinger and Wui-Jin Koh

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NCCN Policy Summit: Cancer Across Geography

Sean T. McCarson, Alyssa Schatz, Victoria Hood, Ashley Orr, Aaron Bailey, Jesse Plascak, Ursa Brown-Glaberman, Elisa M. Rodriguez, Taneal Carter, and Crystal Denlinger

Geographic location of a patient directly impacts access to care, including preventive screenings and early detection. Although there is a higher prevalence of the most common cancers in urban areas, mortality rates are higher in rural communities. Notably, indigenous communities residing on tribal lands often experience heightened access issues and environmental exposure to known and probable human carcinogens. The burdens associated with a cancer diagnosis can be exacerbated by various barriers to accessing quality care; however, there are emerging best practices to overcome these barriers. Understanding the interplay between geography and a patient’s access to cancer care services is crucial for addressing existing disparities and ensuring equitable health care provision across regions. By leveraging innovative policy and practice solutions, communities can begin to close care gaps and establish bidirectional trust between patients and providers across the care continuum, which is necessary to enact meaningful reforms. To advance the conversation on geographic disparities and strategies that mitigate associated barriers to care, NCCN hosted the Policy Summit “Cancer Across Geography” on June 15, 2023, at the National Press Club in Washington, DC. Through keynote addresses and multistakeholder panel discussions, this hybrid event explored care imbalances across geography, recent policy and technology advancements, and current challenges associated with cancer care. This created a forum for a diverse group of attendees to thoughtfully discuss policies and practices to advance high-quality, effective, efficient, equitable, and accessible cancer care for all. Speakers and attendees featured multidisciplinary clinicians, epidemiologists, community oncologists, researchers, payers, patient advocates, industry, providers, policymakers, and leaders representing underserved communities, among others.

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New Targeted Therapies for Metastatic Non–Small Cell Lung Cancer

Presented by: Gregory J. Riely

Biomarker testing is essential for the management of patients with metastatic non–small cell lung cancer (NSCLC) to identify specific actionable mutations and guide treatment decisions in EGFR-mutant disease and for the potential benefit of combining tyrosine kinase inhibitors with chemotherapy to improve progression-free survival. For instance, for patients with EGFR exon 20 insertions, the role of amivantamab, an EGFR-MET–bispecific antibody, is being explored in the first-line and second-line settings, in addition to the use of ROS1 inhibitors, such as repotrectinib, in the treatment of ROS1-rearranged NSCLC. For patients with BRAF V600E mutations, combining BRAF and MEK inhibitors, such as dabrafenib and trametinib or encorafenib and binimetinib, has demonstrated efficacy. The potential of the antibody–drug conjugate fam-trastuzumab deruxtecan-nxki in treating HER2-mutant NSCLC is under investigation. Finally, for patients with KRAS G12C mutations, sotorasib and adagrasib have been tested as second-line therapies, with ongoing trials evaluating their use in the first-line setting.

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Promising Practices to Reduce the Impact of Drug Shortages on Cancer Care

Presented by: Christina Barrington, Rondeep Brar, Laura Bray, Stephen Colvill, Erin R. Fox, and Lalan S. Wilfong

Moderated by: Clifford Goodman

A recent NCCN discussion panel on oncology drug shortages in the United States illuminated the stark contrast between the nation’s health care expenditure and the challenge of ensuring drug availability for cancer treatment. Industry experts across health care disciplines discussed the root causes and consequences of drug shortages, shedding light on the significant impact these shortages have on patient care and health care operations. They also discussed broader systemic failures, such as the lack of manufacturing transparency and flawed supply chains. The conversation called for immediate action, including advocacy and improved drug distribution management, an emphasis on resilience, legislative measures to bolster supply chain robustness, and a complete systematic overhaul to guarantee consistent drug access for cancer care.

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Risk Stratification and Selection of Management Strategy for Localized Prostate Cancer

Presented by: Alice Yu

Localized prostate cancer presents a wide disease spectrum, ranging from indolent cases suitable for active surveillance to aggressive tumors requiring intensive multimodal treatment. Traditional risk stratification tools, such as the D’Amico risk categories and NCCN risk groups, have limitations because of their heterogeneity within each category. Incorporating novel risk stratification strategies, such as genomic classifiers and multimodal artificial intelligence assays, into clinical practice may help refine treatment decisions and optimize outcomes for patients with localized prostate cancer. However, it is important to recognize the limitations of these tools and to use them judiciously in the appropriate clinical contexts.

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Updates in Clinical Management of Pancreatic Cancer

Presented by: Andrew H. Ko

The mainstay of treatment for patients with metastatic pancreatic cancer is chemotherapy, but the development of targeted therapies and immunotherapies heralds a new era in their care. Although actionable alterations are detected infrequently, routine molecular testing should be performed in all patients. The NCCN Guidelines provide the current evidence-based recommendations for maintenance therapy in the metastatic setting. For patients with resectable, borderline resectable, and locally advanced or unresectable tumors, critical questions remain regarding the role of radiation therapy.

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Updates in the Management of Locally Advanced Rectal Cancer

Presented by: Christopher G. Willett

A plethora of advancements in the management of locally advanced rectal cancer continue to be developed. Treatment strategies have primarily focused on modifying the current standard paradigm of rectal cancer management—including the complete omission of surgery or radiotherapy, or instead using immunotherapy as first-line treatment in eligible patients. Recommendations for optimal therapeutic strategies, based on a patient’s clinical stage, have been outlined in the NCCN Guidelines for Rectal Cancer.

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Updates in the Management of Neuroblastoma

Presented by: Rochelle Bagatell

Treatment of children with neuroblastoma depends on accurate assessment of the risk of relapse. Factors used in risk stratification for patients with neuroblastoma include disease stage, MYCN amplification status, age, tumor histology, presence or absence of segmental chromosome aberrations, and tumor cell ploidy. The goal of treatment for patients with low-risk neuroblastoma is cure with minimal toxicity. However, for those with high-risk neuroblastoma, the treatment approach involves multiple therapeutic modalities, including multi-agent chemotherapy at conventional doses, surgery, high-dose chemotherapy with autologous stem cell rescue, external-beam radiotherapy, a differentiating agent, and immunotherapy. Multidisciplinary collaboration is essential for optimal care.

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Updates in the Management of Small Cell Lung Cancer

Presented by: Apar Kishor Ganti

The standard treatment for limited-stage small cell lung cancer (SCLC) is concurrent chemoradiation, with a small subset of patients that could potentially benefit from surgery. For extensive-stage SCLC, the current standard of care is chemoimmunotherapy with a PD-1/PD-L1 inhibitor. The role of prophylactic cranial irradiation in SCLC is currently under debate, and is being investigated in the ongoing MAVERICK trial. Despite high initial response rates to chemoradiotherapy, relapse is common, and outcomes for these patients remain poor. However, recent advances in understanding the molecular biology of SCLC have led to the identification of potential new targets for treatment, including the combination of temozolomide with PARP inhibitors and DLL3-targeted bispecific T-cell engager therapy, both of which have shown activity in early studies.