Leo Gordon, MD, provides an overview of current treatment strategies currently driven by NCCN guidelines.
Leo Gordon, MD: The NCCN [National Comprehensive Cancer Network] is composed of faculty members from comprehensive cancer centers around the country, and there are guidelines in just about every disease area. I am involved and cochair the B-cell lymphoma guidelines, and in the B-cell lymphoma is where diffuse large B-cell lymphoma fits in. First of all, the guideline committees met formally prepandemic in person on a yearly basis. During the pandemic, we [did not meet] so much in person. It was mostly virtual meetings. Now, again we’ve started in-person meetings and it’s a group in B-cell lymphoma [of] about 30 or 35 faculty members composed of…hematologist [and] oncologists. So, clinical people, clinical investigators, radiation oncologists, pathologists, and we’ll get to this later, but there’s also a patient advocate.
There are also members of the NCCN staff that help organize the meetings and record the meetings and provide slides and all. There are other meetings that go on. Certainly, in the B-cell lymphoma group, we meet sometimes a couple of other times virtually a year in response to what we think are important observations. Usually, a manuscript that’s published or even an abstract that’s presented that’s high-impact, or if there is FDA approval of a certain agent or certain drug that occurs outside of the regular meeting time, in order to keep the guidelines current and relevant. We try and meet more than just the regular meeting times and, for important changes to the guidelines, we usually wait for the in-person meetings, but sometimes we’ll make revisions or updates or make somewhat more minor changes during the year. But if there’s an important major change to make, we would make that in the process at the meeting… Everybody has gotten previously sent to them a copy of the latest guidelines and everybody gets to comment on questions they may have, things they may have noticed that don’t make sense, even though they were vetted multiple times. There are new people on the committee and they may not all agree that the conclusions of the guidelines make sense.
During the meeting, somebody will present the new data. It’ll be discussed among the group. And then there are various actions that can be taken if there is really very little data that supports it, and just somebody at a certain cancer center has a bias [for] a certain treatment, but there really isn’t a consensus among the group, that won’t get put on the guidelines or rarely—I don’t think there are too many Category 3’s—it gets put in as a Category 3, which I think carries very little weight. If there’s a randomized clinical trial that shows superiority of one treatment over another, an example of that might be second-line CAR T [chimeric antigen receptor T-cell] therapy in relapsed DLBCL [diffuse large B-cell lymphoma], it’ll go in after a vote, it’ll go in as a Category 1 that there’s randomized clinical trial data and the consensus is greater than 85% of the members of the institutions, not the individual members, but the institutions. Then that can go in as a Category 1 classification. And so, I mean, the process is not perfect, but I think it’s fair and it’s an important process. It’s educational both for myself, I’ve been on this committee for a long time and cochairing it for a long time. And I think it’s educational for the people there. And one of the goals, you’ll probably get to this in a minute, but one of the goals is to make it educational for the practicing oncologist who may see 1 to 5 to 10 B-cell lymphomas in a year and getting comments and advice from people that do nothing but B-cell lymphoma and their clinical activities.
I view the goals as providing a sort of comprehensive, well-referenced, well-thought-out set of guidelines for the practicing oncologist who, again, may not see that particular disease. And that’s true for all of the disease areas in which there are guidelines. So, I think it’s educational, primarily. I know that it has been used to make payer decisions and maybe I’m not sure of this, but I never thought of it as the primary goal. I think that’s…maybe something that’s happened. It’s a secondary goal. It’s fine, it’s good. But I think the primary goal, to me anyway, was education.
Transcript is AI-generated and edited for clarity and readability.