Cardiac risk stratification is clinically useful prior to initiation of oncologic therapy in asymptomatic patients in order to guide treatment decisions and allow for initiation of cardioprotective therapy or modification of treatment regimens. Once oncology treatment is underway, patients may develop cardiac symptoms. In this setting, imaging can be used for assessment of ventricular and valvular function, myocardial characterization, pericardial effusion or constriction, as well as to evaluate for ischemia as a cause of symptoms. Results can help guide treatment choices and shared decision-making regarding modification or cessation of treatments with associated cardiotoxicity. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.

The MASCC/ESMO guidelines for the prevention of chemotherapy- and radiotherapy-induced nausea and vomiting were updated in 2023 by a Consensus Committee of 34 multidisciplinary international healthcare professionals and three patient advocates. Guideline-recommended prophylactic anti-emetic strategies can control chemotherapy-induced nausea and vomiting (CINV) in many patients, but unaddressed issues remain. Across a series of meetings, we evaluated these guidelines to identify possible evidence gaps which warrant further exploration. Key topics identified and discussed included the use of dexamethasone-sparing regimens with cisplatin (and other non-anthracycline and cyclophosphamide)-based highly emetogenic chemotherapy regimens, the importance of individual patient risk factors for CINV, the use of a second agent in patients receiving low emetogenic chemotherapy, how to manage CINV with certain new antibody-drug conjugates, the most appropriate approach for managing breakthrough CINV, the options for patients with CINV even after following best guidance, the use of lower than standard doses of olanzapine (<10 mg/day), and the management of long-delayed CINV and CINV in patients receiving oral therapies. Through identifying the current gaps in the updated MASCC/ESMO guidelines and discussing the available evidence, we aim to address these issues and support oncologists who may encounter them in clinical practice. These and other questions need to be considered to help ensure choice of anti-emetic treatments provide optimal effectiveness in clinical practice.

The cancer burden in the Nordic European countries remains substantial, but new treatment approaches, such as targeted therapy, have increased the survival of cancer patients. During and following cancer treatment regimens, however, patients' quality of life may be severely affected by sequelae, including cutaneous adverse events (cAEs). Overall, practical clinical tools for the management of cAEs in cancer patients and survivors have been lacking.

Immune checkpoint inhibitors (ICIs) have substantially advanced the treatment landscape for a wide variety of malignancies. Older adults represent a large and rapidly growing demographic, among whom ICIs are widely prescribed. Management of ICI-associated toxicity among older adults, particularly in the presence of frailty and comorbidity, poses unique challenges. In this Policy Review, developed by the International Society of Geriatric Oncology (SIOG), we offer an evidence-based framework for health-care providers, caregivers, and policy makers for treating older adults with ICIs, focusing on unique considerations for this population that are not adequately addressed by existing guidelines, and expanding them to encompass geriatric oncology principles.

The KEYNOTE-564 trial showed that adjuvant immune checkpoint inhibitor (ICI) therapy with pembrolizumab, a PD-1 antibody, significantly improved disease-free survival (DFS) and overall (OS) survival in localised clear-cell renal cell carcinoma (RCC) with a high risk of relapse. The TiNivo and CONTACT-03 trials have reported results for subsequent therapy after progression on ICI therapy in the metastatic setting. The European Association of Urology (EAU) RCC guidelines panel reassessed the new trial results to update recommendations for adjuvant therapy and post-adjuvant therapy. Adjuvant pembrolizumab significantly improved OS (hazard ratio 0.62, 95% confidence interval 0.44-0.87; p = 0.005). Recent trials of subsequent ICI after recurrence on ICI in the metastatic setting do not support ICI monotherapy or combination therapy in patients with recurrence on or after adjuvant ICI therapy. There are no prospective trial results for treatment after adjuvant pembrolizumab failure. On the basis of the recent results, the EAU RCC guidelines panel has updated the recommendation for adjuvant therapy and now issues a strong recommendation for adjuvant pembrolizumab. ICI monotherapy or combination therapy is not recommended in patients with recurrence during or shortly after adjuvant pembrolizumab. PATIENT SUMMARY: Treatment with an immunotherapy drug called pembrolizumab after surgery in patients with intermediate-risk or high-risk kidney cancer delays the time to recurrence of cancer and prolongs survival. Therefore, pembrolizumab after surgery is strongly recommended for these patients. However, a significant proportion of patients have life-changing or serious side effects and these must be discussed.

Children and adolescents who are being treated or have been treated for acute leukemia have a secondary immunodeficiency linked to chemotherapy, resulting in an increased risk of infections. Some of which can be prevented by vaccination but its effectiveness is not optimal during chemotherapy. Upon cessation of chemotherapy, the time required for immune reconstitution varies from three months to more than a year, depending on lymphocyte subpopulations, the patient's age, and the intensity of the treatment received. Although they may have regained their immune functions, studies show that most patients have lost part of their vaccine-induced protection post-chemotherapy and require booster doses of vaccines. Most practitioners agree on the importance of vaccinating or revaccinating these children, but practices are heterogeneous among pediatric hematologist-oncologists in France. Based on a practice study and a recent review of the literature, this work aims to propose new French recommendations for the vaccination strategy to be adopted for children and adolescents treated or recently treated for acute leukemia, excluding allogeneic transplant recipients, in 2024. These recommendations specifically include the vaccination protocols for human papillomavirus and meningococcal infections but do not address the COVID-19 vaccination, as its guidelines are subject to rapid changes.

Cancer treatments have been dramatically modified by the introduction and the development of immunological checkpoint inhibitors (ICI). These treatments have many side effects, including acute kidney injury (AKI). Their combination with other treatments makes the diagnosis complex. To provide guidance to physicians treating these patients, the FITC and the SFNDT have developed a set of management guidelines covering pre-treatment assessment, diagnosis of the different types of damage observed, and management of acute interstitial nephritis secondary to ICI. Collaboration between oncologists and nephrologists is mandatory. The development of onconephrology is helping to improve knowledge and identify treatment pathways. The key elements of the diagnostic process are presented. The role of renal biopsy is discussed, as it appears to be underused in relation to the expected benefits. Renal biopsy allows ICI to be continued if AKI is not related to AKI. Treatment based on glucocorticoid therapy is recommended, with regimens depending on the severity of the disease and the renal response to glucocorticoid therapy. Alternative treatments for patients resistant to corticosteroids are discussed, but strong data are lacking. Rechallenge should be discussed since it seems to be associated with a good renal prognosis.

The NCCN Guidelines for the Management of Immunotherapy-Related Toxicities are intended to provide oncology practitioners with guidance on how to manage the wide-ranging and potentially fatal toxicities that may occur with cancer immunotherapy. The guidelines address immune-related adverse events related to immune checkpoint inhibitors, CAR T-cell therapies, and lymphocyte engagers (which include T-cell-engaging bispecific antibodies). These NCCN Guidelines Insights highlight recent guideline updates pertaining to the management of emerging toxicities related to cancer immunotherapy.

This good practice paper (GPP) is intended to support clinicians in assessing patient fitness for bleomycin and in management of bleomycin pulmonary toxicity (BPT) where it occurs. Bleomycin, originally developed as an antibiotic in the 1960s, has been a cornerstone of therapy for classical Hodgkin lymphoma (CHL) since results of its use in combination with doxorubicin, vincristine and dacarbazine (ABVD) were first published by Bonadonna et al in 1975 1. The same author recognised high rates of respiratory morbidity in these patients 2, and bleomycin-;related pulmonary toxicity (BPT) is now a well-;recognised and feared complication with its use. ABVD and BEACOPP/ BEACOPDac (bleomycin, cyclophosphamide, etoposide, doxorubicin, vincristine and prednisolone, with procarbazine or dacarbazine) are standard first-;line treatments in CHL patients, but considerable variation remains in assessing patient fitness for bleomycin both clinically and with respiratory investigations. A recent survey of British haematologists regularly using bleomycin revealed that 87.5% have no local protocols for assessing patients in an evidence-;based fashion, with wide variations in practice captured in the same survey (personal data). A working group was established and a literature review undertaken with the goal of presenting practical recommendations for clinicians regarding bleomycin use based on available evidence and expert opinion.

Corticosteroids are used frequently in oncology and many patients require short- or long-term corticosteroid therapy. General clinical guidelines and recommendations exist on the use of corticosteroids; however, evidence is lacking for recommendations on their appropriate use in older adult with cancer. Treatment of chemotherapy-induced nausea and vomiting (CINV) has dramatically improved over the last decade with 5-hydroxytryptamine type 3 (5-HT3) receptor antagonists and neurokinin-1 (NK-1) receptor antagonists or a combination of both. However, corticosteroids continue to play an important role in the management of acute and delayed CINV prevention. While highly efficacious, the toxicity profile of corticosteroids must be considered, particularly in heterogeneous older patients with multiple comorbidities and polypharmacy. Guidance on corticosteroid-reducing/sparing strategies in this specific population is needed. This consensus, supported by the International Society of Geriatric Oncology, aims to provide evidence-based recommendations for the use of corticosteroid therapy in older adults with cancer.

Extravasation (EV), or the leakage of anticancer drugs into perivascular and subcutaneous tissues during intravenous administration, can cause serious conditions that may require surgical intervention. Therefore, updated guidelines for EV based on systematic review are needed. Additionally, classifications for anticancer drugs that cause EV are not standardized across the current guidelines, and some novel drugs have not been classified. Therefore, this study aimed to formulate guidelines using evidence-based information for shared decision making on prevention, early detection, treatment, and care for EV in Japan and provide additional classification for tissue injury based on systematic review.

In recent years, the treatment of malignant tumors has continually advanced, significantly extending the survival period of cancer patients. Tumors are increasingly present as chronic diseases over the long term, and the cardiovascular toxicity associated with cancer treatment has become increasingly prominent, severely affecting the effective treatment and survival of cancer patients. As a result, cardio-oncology has gained considerable attention as an emerging discipline. However, cardiovascular diseases in cancer patients often have an insidious onset, and early identification and treatment are frequently overlooked. Throughout the course of cancer treatment, it is crucial to reasonably apply cardiac biomarkers for risk stratification, early identification, and screening of cardiovascular diseases in patients, as well as to improve the early diagnosis and treatment levels of cardiovascular diseases in cancer patients. To this end, Cardio-Oncology Group, Chinese Society of Cardiology in conjunction with Cardiovascular Expert Committee, China Medical Doctor Association of Laboratory Medicine, organized experts in relevant fields to compile this consensus. It aims to provide a basis for clinicians to standardize the screening and management of cardiovascular toxicity related to cancer treatment through the reasonable application of cardiac biomarkers.

Global prevalence rates for transgender individuals vary with estimates ranging from 0.3% to 1%, translating to a potential global population of 24.3 million to 81 million. It is estimated that one in two people will develop cancer in their lifetime. Gender-affirming hormone therapy (GAHT) is a common medical intervention for transgender and non-binary individuals. GAHT requires careful consideration for concurrent medical care due to potential drug interactions and physiological changes. A multi-disciplinary team with expertise in transgender health, oncology and pharmacy met to develop a document summarizing current knowledge on the topic for practical use. The team included trans and non-binary authors who shaped the document's language and focus. The document gives a status update on the current understanding of GAHT and how this may intersect with the safe prescribing of systemic anti-cancer therapies (SACT). The document underwent multiple review stages including internal review, review by the British Oncology Pharmacy Association (BOPA) EDI Subcommittee and, finally, BOPA Executive Committee review and final approval. Key recommendations of this document include the use of inclusive and effective communication, vigilant monitoring of kidney function and cardiovascular health, and considerations for hormone receptor-positive cancers. The document also recognizes the multidisciplinary nature of transgender healthcare and where this relates to social prescribing.

A MASCC/ISOO Clinical Practice Statement (CPS) is aimed at generating a concise tool for clinicians that concentrates practical information needed for the management of oral complications of cancer patients. This CPS is focused on the management of oral complications of targeted therapy.

To provide guidance, via multidisciplinary consensus statements, on the safety interactions between systemic anticancer agents (such as radiosensitizing chemotherapy, immunotherapy, targeted therapy, and peptide receptor radionuclide therapy) and transarterial radioembolization (TARE) with yttrium-90 (90Y)-labeled microspheres in the treatment of primary and metastatic liver malignancies.

Accurate assessment of GFR is crucial to guiding drug eligibility, dosing of systemic therapy, and minimizing the risks of both undertreatment and toxicity in patients with cancer. Up to 32% of patients with cancer have baseline CKD, and both malignancy and treatment may cause kidney injury and subsequent CKD. To date, there has been lack of guidance to standardize approaches to GFR estimation in the cancer population. In this two-part statement from the American Society of Onco-Nephrology, we present key messages for estimation of GFR in patients with cancer, including the choice of GFR estimating equation, use of race and body surface area adjustment, and anticancer drug dose-adjustment in the setting of CKD. These key messages are based on a systematic review of studies assessing GFR estimating equations using serum creatinine and cystatin C in patients with cancer, against a measured GFR comparator. The preponderance of current data involving validated GFR estimating equations involves the CKD Epidemiology Collaboration (CKD-EPI) equations, with 2508 patients in whom CKD-EPI using serum creatinine and cystatin C was assessed (eight studies) and 15,349 in whom CKD-EPI with serum creatinine was assessed (22 studies). The former may have improved performance metrics and be less susceptible to shortfalls of eGFR using serum creatinine alone. Since included studies were moderate quality or lower, the American Society of Onco-Nephrology Position Committee rated the certainty of evidence as low. Additional studies are needed to assess the accuracy of other validated eGFR equations in patients with cancer. Given the importance of accurate and timely eGFR assessment, we advocate for the use of validated GFR estimating equations incorporating both serum creatinine and cystatin C in patients with cancer. Measurement of GFR via exogenous filtration markers should be considered in patients with cancer for whom eGFR results in borderline eligibility for therapies or clinical trials.

The survival of pediatric cancer patients has significantly increased thanks to the improvement of oncological treatments. Therefore, it is of utmost importance to manage short- and long-term cardiovascular complications. In pediatric cardio-oncology, there are no recognized guidelines as in adults. Several recommendations and many indications have been derived from the data obtained in the adult cancer population, resulting in greater discrepancies in the clinical management of patients. The aim of this position paper of the Italian Society of Pediatric Cardiology (SICP) is to collect the main evidence regarding the diagnosis, prevention, treatment and follow-up of cardiotoxicity in children, to provide useful indications for clinical practice, and to promote a network between pediatric centers.

Multiple myeloma remains an incurable disease, despite the development of numerous drug classes and combinations that have contributed to improved overall survival. Immunotherapies directed against cancer cell-surface antigens, such as chimeric antigen receptor (CAR) T-cell therapy and T-cell-redirecting bispecific antibodies, have recently received regulatory approvals and shown unprecedented efficacy. However, these immunotherapies have unique mechanisms of action and toxicities that are different to previous treatments for myeloma, so experiences from clinical trials and early access programmes are essential for providing specific recommendations for management of patients, especially as these agents become available across many parts of the world. Here, we provide expert consensus clinical practice guidelines for the use of bispecific antibodies for the treatment of myeloma. The International Myeloma Working Group is also involved in the collection of prospective real-time data of patients treated with such immunotherapies, with the aim of learning continuously and adapting clinical practices to optimise the management of patients receiving immunotherapies.

Chemotherapy-induced nausea and vomiting (CINV) are frequent and dreaded side effects in cancer treatments. CINV has a major impact on patient's condition and quality of life. Prophylaxis is tailored to patient's profile and the emetogenic level of their chemotherapy. The aim of this study is to update the recommendations for CINV prevention and management in pediatric onco-hematology for use in France, by adapting the guidelines of the Pediatric Oncology Group of Ontario (POGO). Clinical practice guideline adaptation is a recognized method for tailoring existing clinical practice guidelines to local context. A multidisciplinary French-speaking panel was formed to discuss about POGO guideline recommendations for the acute and delayed phases, breakthrough, refractory and anticipatory CINV and the evidence supporting them. Panel members were asked whether they wanted to adopt, modify or reject each of the POGO guideline recommendations. Panel members translated each recommendation and adapted recommendations for an implementation in France. Their acceptance required agreement at least 80 % of panel members. Algorithms and tables were created, listing all the recommendations and providing a better overview for decision-making process adapted to the patient's profile. These recommendations should be reviewed for implementation at French institutions caring for pediatric cancer patients and once implemented, the rates of adherence to recommendations and CINV control should be reported.