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Margaret von Mehren, John M. Kane III, Richard F. Riedel, Jason K. Sicklick, Seth M. Pollack, Mark Agulnik, Marilyn M. Bui, Janai Carr-Ascher, Edwin Choy, Mary Connelly, Sarah Dry, Kristen N. Ganjoo, Ricardo J. Gonzalez, Ashley Holder, Jade Homsi, Vicki Keedy, Ciara M. Kelly, Edward Kim, David Liebner, Martin McCarter, Sean V. McGarry, Nathan W. Mesko, Christian Meyer, Alberto S. Pappo, Amanda M. Parkes, Ivy A. Petersen, Matthew Poppe, Scott Schuetze, Jacob Shabason, Matthew B. Spraker, Melissa Zimel, Mary Anne Bergman, Hema Sundar, and Lisa E. Hang

Gastrointestinal stromal tumors (GIST) are the most common type of soft tissue sarcoma that occur throughout the gastrointestinal tract. Most of these tumors are caused by oncogenic activating mutations in the KIT or PDGFRA genes. The NCCN Guidelines for GIST provide recommendations for the diagnosis, evaluation, treatment, and follow-up of patients with these tumors. These NCCN Guidelines Insights summarize the panel discussion behind recent important updates to the guidelines, including revised systemic therapy options for unresectable, progressive, or metastatic GIST based on mutational status, and updated recommendations for the management of GIST that develop resistance to specific tyrosine kinase inhibitors.

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Zhiyuan Zheng, Stacey A. Fedewa, Farhad Islami, Leticia Nogueira, Xuesong Han, Jingxuan Zhao, Weishan Song, Ahmedin Jemal, and K. Robin Yabroff

Background: We sought to examine the lack of paid sick leave among working cancer survivors by sociodemographic/socioeconomic and employment characteristics and its association with preventive services use in the United States. Methods: Working cancer survivors (ages 18–64 years; n=7,995; weighted n=3.43 million) were identified using 2001–2018 National Health Interview Survey data. Adjusted prevalence of lack of paid sick leave by sociodemographic and socioeconomic characteristics, as well as job sector, working hours, and employer size, were generated using multivariable logistic regression models. Separate analyses examined the associations of lack of paid sick leave with use of various preventive services. Results: Of all working cancer survivors, 36.4% lacked paid sick leave (n=2,925; weighted n=1.25 million), especially those working in food/agriculture/construction/personal services occupations or industries (ranging from 54.9% to 88.5%). In adjusted analyses, working cancer survivors with lower household income (<200% of the federal poverty level, 48.7%), without a high school degree (43.3%), without health insurance coverage (70.6%), and who were self-employed (89.5%), were part-time workers (68.2%), or worked in small businesses (<50 employees, 48.8%) were most likely to lack paid sick leave. Lack of paid sick leave was associated with lower use of influenza vaccine (ages 18–39 years, 21.3% vs 33.3%; ages 40–49 years, 25.8% vs 38.3%; ages 50–64 years, 46.3% vs 52.4%; P<.001 for all), cholesterol screening (ages 18–39 years, 43.1% vs 62.5%; P<.05), and blood pressure check (ages 18–39 years, 43.1% vs 62.5%; P<.05) compared with survivors having paid sick leave. Conclusions: In the United States, more than one-third of all working cancer survivors and more than half of survivors working for small employers and in certain occupations/industries lack paid sick leave. Survivors with lower household income or educational attainment are particularly vulnerable. Moreover, lack of paid sick leave is associated with lower use of some recommended preventive services, suggesting that ensuring working cancer survivors have access to paid sick leave may be an important mechanism for reducing health disparities.

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Matthew Barth, Ana C. Xavier, Saro Armenian, Anthony N. Audino, Lindsay Blazin, David Bloom, Jong Chung, Kimberly Davies, Hilda Ding, James B. Ford, Paul J. Galardy, Rabi Hanna, Robert Hayashi, Cathy Lee-Miller, Andrea Judit Machnitz, Kelly W. Maloney, Lianna Marks, Paul L. Martin, David McCall, Martha Pacheco, Anne F. Reilly, Mikhail Roshal, Sophie Song, Joanna Weinstein, Sara Zarnegar-Lumley, Nicole McMillian, Ryan Schonfeld, and Hema Sundar

NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Pediatric Aggressive Mature B-Cell Lymphomas include recommendations for the diagnosis and management of pediatric patients with primary mediastinal large B-cell lymphoma (PMBL) and sporadic variants of Burkitt lymphoma and diffuse large B-cell lymphoma. PMBL is now considered as a distinct entity arising from mature thymic B-cells accounting for 2% of mature B-cell lymphomas in children and adolescents. This discussion section includes the recommendations outlined in the NCCN Guidelines for the diagnosis and management of pediatric patients with PMBL.

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Margaret Tempero

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Daenielle Lang and Kristen K. Ciombor

The global incidence of colorectal adenocarcinoma is stable or decreasing overall; however, the incidence of colorectal cancer in patients aged <50 years is increasing. Although some of this increase is due to hereditary cancer syndromes, this is not the sole explanation. Patients with early-onset rectal cancer in particular have unique disease patterns and face distinct challenges in their treatment. Molecular patterns of disease in this patient cohort are noteworthy and often represent an opportunity to target these cancers more effectively. Recent and ongoing trials focusing on minimizing toxicities and necessary therapy modalities and maximizing response and patient outcome are of paramount importance in this patient population. Additional resources are needed for this patient population, including fertility counseling and preservation, financial guidance, genetic counseling, and psychosocial support.

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Boshen Jiao, Yaw A. Nyame, Josh J. Carlson, Louis P. Garrison Jr, and Anirban Basu

Background: Two pivotal randomized controlled trials (RCTs) demonstrate that abiraterone acetate + prednisone (AAP) combined with androgen deprivation therapy (ADT) significantly extends the survival of men with metastatic hormone-sensitive prostate cancer (mHSPC) compared with ADT alone. Their subgroup analyses indicate that the survival benefit is significant for younger men but not older men. We aimed to assess whether publication of the RCTs was associated with differential real-world AAP utilization by age groups. Methods: Using TriNetX electronic medical records data collected from 43 healthcare organizations across the United States, we performed a difference-in-differences event study among men with newly diagnosed mHSPC observed from June 2014 to June 2019. Eligible subjects were identified based on a comprehensive published algorithm. We analyzed the change in utilization rate of AAP before versus after publication of the RCTs among men aged <70 years versus ≥70 years, adjusting for demographic factors and clinical conditions. Results: Our study included 6,888 men with newly diagnosed mHSPC with 12,738 observations, of whom 46% were aged <70 years. The prepublication trends of AAP utilization were similar between the age groups, whereas publication of the RCTs was associated with a 3.5% higher adjusted uptake rate of AAP among younger men (95% CI, 1.2%–5.8%) relative to older men. This estimate reflects an uptake rate nearly 3 times higher than would have been expected had younger men followed the same utilization trends as older men. The estimates remained consistent throughout the postpublication period. Conclusions: Our study suggests that publication of the RCTs was associated with faster uptake of AAP among younger versus older men with newly diagnosed mHSPC, despite the absence of clinical guidance for differential treatment selection. This finding highlights the importance of confirmatory studies among older men, considering the uncertainties of subgroup analyses in RCTs.