NCCN临床实践指南_不明原发部位肿瘤(2019.V2)英文版

1、Continue NCCN org Version 2 2019 01 23 19 2019 National Comprehensive Cancer Network NCCN All rights reserved NCCN Guidelines and this illustration may not be reproduced in any form without the express written permission of NCCN NCCN Clinical Practice Guidelines in Oncology NCCN Guidelines Occult Primary Cancer of Unknown Primary CUP Version 2 2019 January 23 2019 Continue David S Ettinger MD Chair The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Gauri R Varadhachary MD Vice Chair

2、The University of Texas MD Anderson Cancer Center Daniel W Bowles MD University of Colorado Cancer Center Jeremiah Deneve DO St Jude Children s Research Hospital University of Tennessee Health Science Center Mihaela Druta MD Moffitt Cancer Center Keith D Eaton MD PhD Fred Hutchinson Cancer Research Center Seattle Cancer Center Alliance Joseph Gibbons MD Case Comprehensive Cancer Center University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute David Gierada MD Sitem

3、an Cancer Center at Barnes Jewish Hospital and Washington University School of Medicine G Weldon Gilcrease MD Huntsman Cancer Institute at the University of Utah Kelly Godby MD University of Alabama at Birmingham Comprehensive Cancer Center Angela Jain MD Fox Chase Cancer Center Christina Kong MD Stanford Cancer Institute Jeremy Kortmansky MD Yale Cancer Center Smilow Cancer Hospital Renato Lenzi MD The University of Texas MD Anderson Cancer Center Sam Lubner MD University of Wisconsin Carbone C

4、ancer Center Martin C Mahoney MD PhD Roswell Park Comprehensive Cancer Center John Phay MD The Ohio State University Comprehensive Cancer Center James Cancer Hospital and Solove Research Institute Asif Rashid MD The University of Texas MD Anderson Cancer Center Kerry Reynolds MD Dana Farber Cancer Brigham and Women s Cancer Center I Massachusetts General Hospital Cancer Center Leonard Saltz MD Memorial Sloan Kettering Cancer Center Richard B Schwab MD UC San Diego Moores Cancer Center Chanjuan S

5、hi MD PhD Vanderbilt Ingram Cancer Center Jeffrey B Smerage MD PhD University of Michigan Rogel Cancer Center Marvaretta M Stevenson MD Duke Cancer Institute Daphne B Stewart MD MS City of Hope Comprehensive Cancer Center Harry H Yoon MD Mayo Clinic Cancer Center Matthew B Yurgelun MD Dana Farber Cancer Brigham and Women s Cancer Center I Massachusetts General Hospital Cancer Center Weining Ken Zhen MD Fred the minus was removed Ovarian serous carcinoma modified p53 diffuse abnormal CDX2 was del

6、eted p16 diffuse strong is a new addition SATB2 moved to ovarian mucinous carcinoma 5 of 5 Polyclonal CEA was deleted from the column Other positive markers for Upper gastrointestinal tract carcinoma including esophagus and stomach OCC B 2 of 4 Adenocarcinoma Paclitaxel 175 200 mg m2 Carboplatin AUC 5 6 also for Squamous cell Gemcitabine 1000 1250 mg m2 Cisplatin 75 100 mg m2 also for Squamous cell FOLFIRI is new to the page with 5 corresponding references Updates in Version 1 2019 of the NCCN G

7、uidelines for Occult Primary from Version 1 2018 include Updates in Version 2 2019 of the NCCN Guidelines for Occult Primary from Version 1 2019 include OCC A 1 of 5 Per physician discretion TRK protein testing can be considered as part of broad immunohistochemistry testing a positive test should then be confirmed with NGS Drilon A Laetsch TW Kummar S et al Efficacy of larotrectinib in TRK fusion positive cancers in adults and children N Engl J Med 2018 378 731 739 MS 1 The Discussion section ha

8、s been updated to reflect the changes to the algorithm NCCN Guidelines Version 2 2019 Occult Primary Version 2 2019 01 23 19 2019 National Comprehensive Cancer Network NCCN All rights reserved NCCN Guidelines and this illustration may not be reproduced in any form without the express written permission of NCCN NCCN Guidelines Index Table of Contents Discussion Printed by Maria Chen on 1 23 2019 9 00 47 PM For personal use only Not approved for distribution Copyright 2019 National Comprehensive C

9、ancer Network Inc All Rights Reserved OCC 1 aFor many patients the apparent uncertainties surrounding the diagnosis of an unknown primary cancer may result in significant psychosocial distress and increased difficulty in accepting treatment options Empathetic discussion about the natural history of these types of cancer and their prognosis and the provision of support and counseling both by the primary oncology team and specialized services may help to alleviate this distress See NCCN Guidelines

10、 for Distress Management bCT MRI imaging should be performed with IV contrast unless contraindicated cThe population of patients with MSI high MMR deficient MSI H dMMR occult primary tumors is low Use IHC for MMR or PCR for MSI which are different assays measuring the same biological effect dSee Immunohistochemistry Markers for Unknown Primary Cancers OCC A eThere may be diagnostic benefit though not necessarily clinical benefit The use of gene signature profiling is a category 3 recommendation

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