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Robert J. Motzer, Eric Jonasch, Neeraj Agarwal, Sam Bhayani, William P. Bro, Sam S. Chang, Toni K. Choueiri, Brian A. Costello, Ithaar H. Derweesh, Mayer Fishman, Thomas H. Gallagher, John L. Gore, Steven L. Hancock, Michael R. Harrison, Won Kim, Christos Kyriakopoulos, Chad LaGrange, Elaine T. Lam, Clayton Lau, M. Dror Michaelson, Thomas Olencki, Phillip M. Pierorazio, Elizabeth R. Plimack, Bruce G. Redman, Brian Shuch, Brad Somer, Guru Sonpavde, Jeffrey Sosman, Mary Dwyer and Rashmi Kumar

disease burden is limited or patients remain symptomatic. Additionally, RT along with bisphosphonates is considered for palliation, particularly for painful bone metastases. The frequency of clinic visits or radiographic and laboratory assessments depends

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Cynthia L. Gong and Joel W. Hay

remain on bisphosphonates in each study provided they had been receiving treatment before study initiation. 4 , 5 This may also have led to the lack of SREs being reported in either clinical trial. Because SREs may significantly impact morbidity in mCRPC

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R. Michael Tuttle, Robert I. Haddad, Douglas W. Ball, David Byrd, Paxton Dickson, Quan-Yang Duh, Hormoz Ehya, Megan Haymart, Carl Hoh, Jason P. Hunt, Andrei Iagaru, Fouad Kandeel, Peter Kopp, Dominick M. Lamonica, William M. Lydiatt, Judith McCaffrey, Jeffrey F. Moley, Lee Parks, Christopher D. Raeburn, John A. Ridge, Matthew D. Ringel, Randall P. Scheri, Jatin P. Shah, Steven I. Sherman, Cord Sturgeon, Steven G. Waguespack, Thomas N. Wang, Lori J. Wirth, Karin G. Hoffmann and Miranda Hughes

combinations that include dacarbazine. 62 , 73 , 74 EBRT can be used for focal symptoms. Bisphosphonate therapy or denosumab can be considered for bone metastases. 75 – 77 Best supportive care is also recommended. Sorafenib or sunitinib can be considered

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NCCN Guidelines Insights: Multiple Myeloma, Version 1.2020

Featured Updates to the NCCN Guidelines

Shaji K. Kumar, Natalie S. Callander, Jens Hillengass, Michaela Liedtke, Muhamed Baljevic, Erica Campagnaro, Jorge J. Castillo, Jason C. Chandler, Robert F. Cornell, Caitlin Costello, Yvonne Efebera, Matthew Faiman, Alfred Garfall, Kelly Godby, Leona Holmberg, Myo Htut, Carol Ann Huff, Yubin Kang, Ola Landgren, Ehsan Malek, Thomas Martin, James Omel, Noopur Raje, Douglas Sborov, Seema Singhal, Keith Stockerl-Goldstein, Carlyn Tan, Donna Weber, Alyse Johnson-Chilla, Jennifer Keller and Rashmi Kumar

should be discontinued and other metabolic abnormalities corrected, such as hypercalcemia and hyperuricemia. Hydration, bisphosphonates, denosumab, and/or calcitonin are recommended to reduce calcium levels in the case of hypercalcemia. In patients with

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Robert A. Swarm, Judith A. Paice, Doralina L. Anghelescu, Madhuri Are, Justine Yang Bruce, Sorin Buga, Marcin Chwistek, Charles Cleeland, David Craig, Ellin Gafford, Heather Greenlee, Eric Hansen, Arif H. Kamal, Mihir M. Kamdar, Susan LeGrand, Sean Mackey, M. Rachel McDowell, Natalie Moryl, Lisle M. Nabell, Suzanne Nesbit, BCPS, Nina O’Connor, Michael W. Rabow, Elizabeth Rickerson, Rebecca Shatsky, Jill Sindt, Susan G. Urba, Jeanie M. Youngwerth, Lydia J. Hammond and Lisa A. Gurski

, including gel or patch, may provide relief for pain due to bone metastases with minimal system effects. 220 Although bone-modifying agents such as bisphosphonates and RANKL (receptor activator of nuclear factor-kappa-B ligand) inhibitors are primarily used

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Miren Gaztañaga and Juanita Crook

mg daily) and vitamin D (800–1000 IU daily) for all men older than 50 years, and additional treatment for those at higher risk. Bisphosphonates increase bone mineral density and reduce the risk of fracture. 51 – 53 Currently, treatment with either

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Dawn Goetz

/progesterone. Patients with distant metastases may undergo chemotherapy, immunotherapy, or secondary hormonal therapy. Those with bony metastases may receive bisphosphonates or radionuclide therapy using samarium or strontium. Zoledronic acid is recommended every 3 to 4

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Robert W. Carlson, Susan Moench, Arti Hurria, Lodovico Balducci, Harold J. Burstein, Lori J. Goldstein, William J. Gradishar, Kevin S. Hughes, Mohammad Jahanzeb, Stuart M. Lichtman, Lawrence B. Marks, Joan S. McClure, Beryl McCormick, Lisle M. Nabell, Lori J. Pierce, Mary Lou Smith, Neal S. Topham, Tiffany A. Traina, John H. Ward and Eric P. Winer

fracture. 136 , 137 The use of the potent bisphosphonates is also valuable in patients with bone metastasis from breast cancer. 7 , 136 Ongoing Questions: What target hemoglobin level should be recommended for older patients with breast cancer? Should

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William J. Gradishar, Benjamin O. Anderson, Sarah L. Blair, Harold J. Burstein, Amy Cyr, Anthony D. Elias, William B. Farrar, Andres Forero, Sharon Hermes Giordano, Lori J. Goldstein, Daniel F. Hayes, Clifford A. Hudis, Steven J. Isakoff, Britt-Marie E. Ljung, P. Kelly Marcom, Ingrid A. Mayer, Beryl McCormick, Robert S. Miller, Mark Pegram, Lori J. Pierce, Elizabeth C. Reed, Kilian E. Salerno, Lee S. Schwartzberg, Mary Lou Smith, Hatem Soliman, George Somlo, John H. Ward, Antonio C. Wolff, Richard Zellars, Dorothy A. Shead and Rashmi Kumar

treat osteoporosis or osteopenia in women with breast cancer is discouraged. The use of a bisphosphonate is generally the preferred intervention to improve bone mineral density. Optimal duration of bisphosphonate therapy has not been established. Factors

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Robert Swarm, Amy Pickar Abernethy, Doralina L. Anghelescu, Costantino Benedetti, Craig D. Blinderman, Barry Boston, Charles Cleeland, Nessa Coyle, Oscar A. deLeon-Casasola, June G. Eilers, Betty Ferrell, Nora A. Janjan, Sloan Beth Karver, Michael H. Levy, Maureen Lynch, Natalie Moryl, Barbara A. Murphy, Suzanne A. Nesbit, Linda Oakes, Eugenie A. Obbens, Judith A. Paice, Michael W. Rabow, Karen L. Syrjala, Susan Urba and Sharon M. Weinstein

Acetaminophen 59 ; NSAIDs including selective COX-2 inhibitors; tricyclic antidepressants; anticonvulsant drugs; bisphosphonates; and hormonal therapy are among the most commonly used medications. The NSAID and acetaminophen prescribing guidelines are presented