NCCN Guidelines for Gastric Cancer V.1.

2023 Annual on 08/30/22

Guideline Page Panel Discussion/References Vote

and Request
GAST-F (4 of 17)
Internal request
Reassess the data for docetaxel, carboplatin, and
fluorouracil as a first-line therapy option.
GAST-F (5 of 17)
External request
Submission from Bristol Meyers Squibb (04/11/22)
requesting the panel’s consideration of the enclosed data
and to include nivolumab in combination with ipilimumab as
a treatment option for patients with tissue TMB-H (tTMB-H)
gastric cancer who are refractory to standard therapies or
have no standard treatment options available.
GAST-F (5 of 17)
Internal request
Consider adding Dabrafenib and trametinib as a second-line
or subsequent therapy option for the treatment of BRAF
V600E mutated gastric cancer.
YES NO ABSTAIN ABSENT
Based on a review of the data and discussion, the 0 24 1 8
panel consensus supported removing docetaxel,
carboplatin, and fluorouracil as a first-line therapy
option for patients with gastric cancer.
Based on a review of the data and discussion, the 0 24 1 8
panel consensus did not support the inclusion of
nivolumab in combination with ipilimumab as a
second-line or subsequent therapy option for
patients with tissue TMB-H (tTMB-H) gastric
cancer.
Based on the review of the panel consensus was 24 0 1 8
to include dabrafenib and trametinib as a second-
line or subsequent therapy option for BRAF
V600E mutated gastric cancer. This is a category
2A, [useful in certain circumstances]
recommendation.

Salama AKS, Li S, Macrae ER, et al. Dabrafenib

GAST-D (1 of 7)
External request
Submission from Ambry Genetics, GeneDx (Sema4),
illumina, Myriad Genetic Laboratories, Inc., Quest
Diagnostics Laboratories requesting the following:
and Trametinib in Patients With Tumors With
BRAF(V600E) Mutations: Results of the NCI-
MATCH Trial Subprotocol H. J Clin Oncol
2020;38:3895-3904.
The Panel consensus was to defer the submission 24 0 1 8
until the publication of a future interim update.

1. Recommend verbiage change regarding evaluation

of individuals presenting for risk assessment:
a. Please substitute the first bullet point under
“Criteria for Further Risk Evaluation for
High-Risk Syndromes” as follows: Genetic
risk assessment, counseling and germline
genetic testing is clinically indicated for an
individual with one or more of the following:
2. Recommend additional criteria for further risk
evaluation for high-risk syndromes:
NCCN Guidelines for Gastric Cancer V.1.2023 Annual on 08/30/22

a. Please add the following bullets to the list:

i. The presence of one or more
pathogenic variants in known
hereditary cancer genes detected
through tumor testing.
ii. If the tumor is determined to be
MSI-High by PCR, NGS or other
DNA analysis, or IHC analysis.
3. Request for clarification of existing criteria:
a. Please reword and divide the last bullet
under the “Or a family history of” section as
follows to improve clarity:
i. Gastric and breast cancer in a first
or second degree relative, with
one diagnosis before age 50, or
ii. Gastric cancer at any age in a first
or second degree relative, and a
family history of juvenile polyps or
gastrointestinal polyposis.
b. On pages GAST-D 1 and GAST-D 2, some
of the family history criteria are based on first-
or second-degree relatives, and others based
on “close relatives”, defined on page GAST-D 2
as first-, second- or third-degree relatives.
Insert the following in footnote at the bottom of
GAST-D1 to define a “close relative”
A close relative is defined as a first-, second-,
or third-degree relative. First-degree relatives
include parents, siblings, and offspring. Second
degree relatives include grandparents, aunts,
and uncles. Third-degree relatives include
cousins and great grandparents.