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Presented by: Joyce F. Liu

Treatment approaches for advanced ovarian cancer should consider several factors. Among the most important are platinum sensitivity, the status of BRCA and homologous recombination deficiency (HRD), and the changing indications for PARP inhibitors in recurrent disease and maintenance. PARP inhibitors have demonstrated clear benefit in patients with BRCA mutated tumors, especially in the first-line setting, and HRD testing can guide their use for patients without BRCA mutations. A new antibody–drug conjugate, mirvetuximab soravtansine, has been approved for use in a subset of patients with platinum-resistant disease. Newly diagnosed patients with advanced-stage ovarian, fallopian tube, or primary peritoneal cancers should always be evaluated by a gynecologic oncologist if possible.

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Presented by: Archana Ajmera, Rana R. McKay, and Kelly L. Stratton

Androgen deprivation therapy is a well-established standard of care for the management of metastatic prostate cancer; however, recent studies have investigated additional therapeutic options, escalation strategies, and primary directed therapy for patients with advanced disease. Treatment decisions are based on clinical parameters, disease characteristics, and patient factors. At the NCCN 2023 Annual Conference, a panel of experts used 3 case studies to develop an evidence-based approach for the treatment of patients with metastatic prostate cancer. The session focused on the current research regarding both systemic and local therapy options in each clinical context.

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Presented by: Nadeem R. Abu-Rustum

Cervical cancer often affects individuals aged <50 years, with the main cause being a long-lasting infection with certain types of human papillomavirus (HPV). Prevention of cervical cancer includes screening tests and the HPV vaccine and, if found early, it can be treatable. Metastatic disease, however, is more lethal and is a significant problem worldwide due to screening and treatment limitations. Clinicians should discuss early detection options and treatment modalities with patients with cervical cancer for informed decision-making.

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Presented by: Natalie S. Callander

The treatment of relapsed multiple myeloma is based in part on the degree of previous exposure and resistance to commonly used drug classes. For patients with a first relapse, an anti-CD38 antibody–based combination is preferred unless patients have already received these agents, in which case a carfilzomib-based option can be an excellent choice. For patients with more refractory disease, a bispecific antibody is an emerging choice, but CAR T-cell therapy should also be considered for some patients; other options include salvage autologous transplantation, recycling of previous therapies, and selinexor-based therapies. Emerging new classes of drugs in development are poised to broaden the treatment possibilities for relapsed disease.

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Presented by: Craig M. Horbinski and L. Burt Nabors

In 2021, the WHO revised its classification of central nervous system (CNS) tumors, which has resulted in changes to both the diagnostic and treatment landscapes. At the NCCN 2023 Annual Conference, this tumor board–style presentation featured 4 case studies to demonstrate an evidence-based approach to the treatment of patients with various WHO-defined types of diffuse glioma. The NCCN Guidelines have been updated to reflect the WHO reclassification of CNS tumors and provide treatment recommendations accordingly.

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NCCN Guidelines® Insights: Breast Cancer, Version 4.2023

Featured Updates to the NCCN Guidelines

William J. Gradishar, Meena S. Moran, Jame Abraham, Vandana Abramson, Rebecca Aft, Doreen Agnese, Kimberly H. Allison, Bethany Anderson, Harold J. Burstein, Helen Chew, Chau Dang, Anthony D. Elias, Sharon H. Giordano, Matthew P. Goetz, Lori J. Goldstein, Sara A. Hurvitz, Rachel C. Jankowitz, Sara H. Javid, Jairam Krishnamurthy, A. Marilyn Leitch, Janice Lyons, Joanne Mortimer, Sameer A. Patel, Lori J. Pierce, Laura H. Rosenberger, Hope S. Rugo, Bryan Schneider, Mary Lou Smith, Hatem Soliman, Erica M. Stringer-Reasor, Melinda L. Telli, Mei Wei, Kari B. Wisinski, Jessica S. Young, Kay Yeung, Mary A. Dwyer, and Rashmi Kumar

The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Breast Cancer address all aspects of management for breast cancer. The treatment landscape of metastatic breast cancer is evolving constantly. The therapeutic strategy takes into consideration tumor biology, biomarkers, and other clinical factors. Due to the growing number of treatment options, if one option fails, there is usually another line of therapy available, providing meaningful improvements in survival. This NCCN Guidelines Insights report focuses on recent updates specific to systemic therapy recommendations for patients with stage IV (M1) disease.

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Presented by: Deborah M. Stephens

Chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) is characterized by the accumulation of abnormal lymphocytes in the blood, bone marrow, and lymphoid tissues, leading to a weakened immune system and an increased risk of infections for patients. The NCCN Guidelines for CLL/SLL underscore the need for a comprehensive evaluation of multiple factors to determine the most appropriate treatment approach for each patient. For frontline therapy, the selection process should consider the patient’s IGHV status, del(17p)/TP53 mutation status, age, and comorbidities. In choosing subsequent therapy, prior therapy, comorbidities, and resistance mutations should be considered. With no clear evidence of a functional cure, it is important to enroll patients in clinical trials when available.

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Presented by: Steven Nurkin

Excellent long-term outcomes are being achieved with contemporary treatment strategies for localized rectal cancer. A “watch-and-wait” nonoperative strategy seems to be a safe option for patients experiencing a complete clinical response. Total neoadjuvant therapy (TNT) has shown many advantages over standard chemoradiotherapy, although the optimal sequencing—with induction or consolidation chemotherapy—is still debated. The use of FOLFIRINOX can boost the benefit of TNT. Of note, in the small subset of patients whose tumors have mismatch repair deficiency, checkpoint inhibition has led to responses in most patients, eliminating the need for further treatment.