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In the absence of universally accepted staging systems, the assessment of both basal and squamous cell carcinomas presents a formidable challenge. The NCCN Guidelines, which reflect the most up-to-date, evidence-based data relating to the evaluation and management of these nonmelanoma neoplasms, provide criteria for their risk stratification. Moreover, the current treatment algorithms discussed to aid in risk category–based clinical decision-making. Case reports demonstrate the practical application of the NCCN Guidelines and highlight the importance of a multidisciplinary approach.

Approximately 24 million people in the United States identify as transgender, non-binary, or gender-diverse, and they often face challenges in accessing health care related to education, employment, and economic circumstances. In addition, their gender identity can create other hurdles to receiving appropriate health care, as well as gender dysphoria caused by procedures and preventive cancer screening that do not align with their current gender identity. It is important to consider hereditary risk and gender identity together. Clinicians should engage patients in creating a personalized plan (focusing on genetic risk; age-specific risk; sex assigned at birth and organs present at birth; gender identity; and gender-affirming surgeries and medications) and work with colleagues across medical disciplines to meet the health care needs of this fast-growing patient population.

Clinical genetics is an ever-changing field of medicine that has undergone significant advancements. Therefore, efforts to identify the critical components of a comprehensive cancer risk assessment are imperative. The combined approach of thorough information gathering, effective genetic counseling, and continued post-testing management has been adopted as a strategic approach to risk assessment.

Microsatellite status should be assessed in all upper and lower gastrointestinal (GI) cancers. If an upper GI cancer is microsatellite instable (MSI), clinicians should consider treatment with an immune checkpoint inhibitor (ICI) or a combination of ICIs instead of chemotherapy. Immunotherapy is also active in lower GI cancers, where treatment is driven by microsatellite status. For upper GI cancers, the benefit has mostly been shown in the neoadjuvant and metastatic settings. In colorectal cancer, most of the benefit has been established in metastatic disease, although the use of immunotherapy in the neoadjuvant and adjuvant settings is an active area of research. In rectal cancer, a response benefit has been established for ICI as neoadjuvant therapy, although survival outcomes have not matured.

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.

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.

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.

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.

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.