PURPOSE: Cardiovascular (CV) toxicity is prevalent in cancer survivors due to shared risk factors, direct CV injury from cancer therapy (CT), and development/exacerbation of CV risk factors during treatment. Succinct guidance on the minimum standard of CV care required of cancer care providers (CCPs) can improve outcomes for survivors. This clinical practice statement (CPS) is aimed at CCPs focused on identification, prevention, and management of CVD in individuals with cancer. METHODS: The International Cardio-Oncology Society and Multinational Association of Supportive Care in Cancer identified members with expertise across oncology, cardiology, and cancer survivorship. Key questions/areas of practice recommendations related to CV risk and CVD were identified across the cancer trajectory.Working groups performed targeted literature reviews and consensus was reached for all recommendations. RESULTS: 5 over-arching clinical practice recommendations for CCPs were identified: (1) perform a CV risk assessment prior to starting CT (2) identify and facilitate CV-related care during CT; (3) ensure measures are taken to mitigate the risk of cancer therapy related CV toxicity (CTR-CVT) prior to and during CT; (4) monitor CV status and risk factors during therapy and refer to the appropriate health care provider if CV risk factors are uncontrolled or new signs/symptoms develop; and (5) re-assess CV risk following completion of CT (periodically for those with advanced disease on life long treatment) and develop a CV surveillance plan. CONCLUSIONS: CCPs play a pivotal role in identifying and addressing CTR-CVT. This CPS provides specific, succinct, and actionable behaviours that can be readily implemented in cancer care globally.

Cancer therapy-related cardiac dysfunction (CTRCD) has become an important clinical issue with advances in cancer treatment and improved patient survival. The Japanese Society of Echocardiography previously published practice guidance in 2020. The present document provides an updated revision reflecting recent developments in cardio-oncology.

To update the ASCO guideline on use of hematopoietic colony-stimulating factors (CSFs) in patients with cancer.

Febrile neutropenia, a common complication of systemic antineoplastic therapy, varies in risk depending on malignant disease, treatment, and patient factors. The risk increases with the depth and duration of neutropenia and can be reduced with prophylactic use of G-CSF. International guidelines are conflicting in several aspects and do not reflect all patient groups. We therefore updated the 2014 Infectious Diseases Working Party (AGIHO) guideline of the German Society of Hematology and Medical Oncology (DGHO) on evidence-based recommendations for the use of G-CSF in patients with cancer.

Neutropenic fever is a common complication of haematology and oncology treatments and is associated with a significant risk of morbidity and mortality. Few studies report patients' and carers' understanding of neutropenic fever, including risk reduction, recognition and optimal management. This guideline aims to improve communication around prevention, recognition and management strategies for neutropenic fever in patients receiving cancer treatment. Medical specialists, allied health physicians, other key stakeholders, parents and carers, and patient consumers collaborated to develop guidelines for patients and carers on neutropenic fever. This addition to the 2024 Australasian Consensus Guidelines for the Management of Neutropenic Fever in Patients with Cancer is the first directed at healthcare workers treating paediatric and adult patients at risk of neutropenic fever.

Patients preparing to undergo therapies that pose a risk to their fertility or who are at risk of premature ovarian insufficiency should be provided prompt counseling regarding available options for fertility preservation. Fertility preservation can best be provided by comprehensive programs designed and equipped to confront the unique challenges facing these patients. This document replaces the document entitled "Fertility preservation in patients undergoing gonadotoxic therapy or gonadectomy: a committee opinion," last published in 2019.

Current guidelines for managing infections in pediatric patients with cancer do not recommend routine antibiotic prophylaxis (AP). However, several aspects of AP, including the role of diagnosis, the impact of neutropenia duration, screening for resistant bacterial colonization, and antibiotic stewardship, remain a matter of debate.

Asparaginase is an integral component of therapy for pediatric patients with acute lymphoblastic leukemia/lymphoblastic lymphoma. The success of asparaginase-containing regimens has led to trials of pediatric/pediatric-inspired regimens incorporating asparaginase for treating adolescent and young adult (AYA) and adult populations with acute lymphoblastic leukemia/lymphoblastic lymphoma. While treatment of AYA patients with these regimens is associated with improved clinical outcomes compared with adult-specific protocols, AYA patients face unique challenges with these treatments, further complicated by a rapidly evolving therapeutic landscape. In this article, we identify barriers and other feasibility issues associated with administering asparaginase-based treatment to AYA patients and provide recommendations from a consensus panel of experts to optimize AYA patient outcomes and experiences. Barriers identified include the limited access to clinical trials and specialized expertise in pediatric-inspired regimens for AYA patients compared with pediatric patients, the complex management of asparaginase toxicities, limited medical facilities and experienced staff to administer and manage pediatric-inspired regimens, and reduced AYA patient access/adherence to treatment due to lifestyle-related or psychosocial challenges. Recommendations are provided on addressing and managing these challenges to improve asparaginase-based treatment accessibility and safety in AYA patients, including specific recommendations for high-risk populations. Trial Registration: ClinicalTrials.gov: NCT04817761.

Extravasation is an uncommon but high-risk adverse event that occurs when an agent with the potential to cause tissue damage leaks out of the intended administration space into the surrounding area. This guideline presents evidence-based side effect management recommendations to support interprofessional teams in decision-making to minimize severity or progression of extravasation injury from antineoplastic treatment in individuals with cancer.

The conventional drug development pathway in oncology, spanning 10-15 years, has long been slow, costly, and complex, often marked by late-stage failures due to efficacy or safety concerns.

ASCO Guidelines provide recommendations with comprehensive review and analyses of the relevant literature for each recommendation, following the guideline development process as outlined in theASCO Guidelines Methodology Manual. ASCO Guidelines follow theASCO Conflict of Interest Policy for Clinical Practice Guidelines.Clinical Practice Guidelines and other guidance ("Guidance") provided by ASCO is not a comprehensive or definitive guide to treatment options. It is intended for voluntary use by clinicians and should be used in conjunction with independent professional judgement. Guidance may not be applicable to all patients, interventions, diseases or stages of diseases. Guidance is based on review and analysis of relevant literature, and is not intended as a statement of the standard of care. ASCO does not endorse third-party drugs, devices, services, or therapies and assumes no responsibility for any harm arising from or related to the use of this information. See complete disclaimer in Appendix 1 and 2 (online only) for more.

Immune checkpoint inhibitors (ICIs) are being increasingly used in patients with preexisting inflammatory arthritides (IAs). However, there are concerns that concomitant baseline immunosuppression at the time of ICI initiation may worsen cancer outcomes, a risk that needs to be balanced with the risk of IA flare. The objective of this study was to develop a living guideline that will offer up-to-date guidance on the management of baseline immunosuppression for preexisting IAs when initiating cancer immunotherapy with ICIs.

An evidence-based clinical practice guideline for systemic cancer treatment in pregnant women is lacking.

How should fertility preservation in child and adolescent males receiving gonadotoxic therapies be managed?

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.

Childhood, adolescent, and young adult (CAYA) survivors of cancer are at risk of nephrotoxicity. Surveillance guidelines are important for timely diagnosis and treatment of these survivors, which could slow the progression to higher stages of kidney dysfunction.

Belzutifan offers a significant therapeutic advance for von Hippel-Lindau-associated and advanced renal cell carcinoma but is associated with notable toxicities, particularly anemia and hypoxia. Effective management requires vigilant monitoring, timely interventions, and dose adjustments.

Survival rates after a diagnosis of cancer are improving. Poorly managed gastrointestinal (GI) side effects can interfere with delivery of curative cancer treatment. Long-term physical side effects of cancer therapy impinge on quality of life in up to 25% of those treated for cancer, and GI side effects are the most common and troublesome.

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.

Paediatricians across many specialities and pharmacists are increasingly being asked to prescribe, or jointly look after, children treated with mammalian target of rapamycin (mTOR) inhibitors (eg, sirolimus and everolimus). There is an expanding list of conditions including tuberous sclerosis and vascular malformations where treatment with mTOR inhibitors may help. This brief practice pointer summarises the practical steps before starting these treatments, what potential side effects to discuss with families and what monitoring arrangements should be put in place.