The National Comprehensive Cancer Network (NCCN) released its first set of Clinical Practice Guidelines in Oncology (NCCN Guidelines®) in 1996, covering eight tumor types. Today, guidelines are available for more than 60 tumor types, subtypes, and related topics. During the NCCN’s 30th Annual Conference, updates to the guidelines were presented for several of those malignancies. We briefly outline here the latest key recommendations.
Bladder Cancer
“There have been dramatic changes in the way we think about and address the care of patients with bladder cancer.”
—Thomas W. Flaig, MD
Updates in bladder cancer were presented by Thomas W. Flaig, MD, of the University of Colorado Cancer Center, Aurora, and Philippe E. Spiess, MD, MS, FACS, FRCSC, of the Moffitt Cancer Center and the University of South Florida, Tampa.
Thomas W. Flaig, MD
Philippe E. Spiess, MD, MS, FACS, FRCSC
Dr. Spiess told The ASCO Post: “There have been a host of new treatments that have been developed for bacillus Calmette-Guérin [BCG]-unresponsive [non–muscle-invasive bladder cancer].” The immune cell–activating interleukin-15 superagonist nogapendekin alfa inbakicept-pmln plus BCG was recently added to the NCCN Guidelines as an initial management option in this clinical context for patients with high-risk disease with carcinoma in situ (with or without papillary) tumors.
The current version also encompasses revisions to the Principles of Systemic Therapy section. At the conference, Dr. Flaig highlighted the following key updates for muscle-invasive and metastatic disease:
Neoadjuvant gemcitabine plus cisplatin with perioperative durvalumab now represents the “preferred” and only recommendation for perioperative/sandwich therapy (bladder cancer only; category 1). This approach introduces a new treatment strategy in this setting, involving immunotherapy before and after surgery (ie, perioperative/sandwich therapy).
Sacituzumab govitecan-hziy was an “other recommended” subsequent-line regimen for locally advanced or metastatic disease (stage IV), but it is now considered “useful in certain circumstances” for both second-line therapy (with prior chemotherapy and immunotherapy) and subsequent-line therapy (with prior chemotherapy, immunotherapy, and enfortumab vedotin-ejfv). The U.S. Food and Drug Addministration (FDA) withdrew the approval for sacituzumab govitecan for advanced or metastatic urothelial carcinoma in late 2024.
Fam-trastuzumab deruxtecan-nxki (T-DXd; for HER2-positive, immunohistochemistry [IHC] 3+) has been added into a new table for biomarker-directed therapy, regardless of previous therapy, and recommended as a “preferred” second-line and subsequent-line regimen for some patients with locally advanced or metastatic disease (stage IV).
Dr. Flaig discussed some of the organizational changes to the NCCN Guidelines over the past year, specifically related to systemic therapy for locally advanced or metastatic disease (stage IV): “If you looked at these Guidelines a few years ago, we organized [the first-line recommendations] by cisplatin-eligible and -ineligible….” Now, although no longer following this structure, they still offer guidance for the treatment of cisplatin-ineligible patients. “[Regarding second-line therapy, the Guidelines have now] been organized into thinking about previous exposure to immunotherapy and enfortumab vedotin,” he added.
There has been a broad incorporation of immune checkpoint inhibitor therapy into the treatment of urothelial carcinoma, with these agents now included in all of the preferred and other recommended first-line systemic therapy regimens for locally advanced or metastatic disease.
Differentiated Thyroid Cancer
“Thyroid cancers are poster children for precision oncology.”
—Lori J. Wirth, MD
Lori J. Wirth, MD
“Every patient [with differentiated thyroid cancer] who is going to get systemic therapy should have next-generation sequencing testing done,” commented Lori J. Wirth, MD, of Mass General Cancer Center and Harvard Medical School, Boston. In a discussion with The ASCO Post, she highlighted that the “most important” recent updates to the NCCN Guidelines pertain to NTRK and RET gene fusion–specific therapies for those with progressive and/or symptomatic radioactive iodine–refractory papillary carcinoma, radioactive iodine–refractory follicular carcinoma, and oncocytic carcinoma:
- Repotrectinib was added as “useful in certain circumstances” for the treatment of NTRK gene fusion–positive advanced solid tumors.
- The recommendation for selpercatinib for RET gene fusion–positive tumors (useful in certain circumstances) has been revised to reflect its expanded FDA approval for use in pediatric patients aged at least 2 years.
“Coming soon is an international phase III trial of second-line dabrafenib plus trametinib in BRAF V600E–positive [papillary] thyroid cancer,” Dr. Wirth told The ASCO Post, which may impact future recommendations in the NCCN Guidelines. Of note, the combination is currently listed as “useful in certain circumstances” in this setting (in the absence of satisfactory alternatives) for the abovementioned populations of patients with progressive and/or symptomatic disease.
Although not FDA-approved, pembrolizumab plus lenvatinib (for disease progression on lenvatinib) and pemetrexed plus carboplatin (for disease progression after prior treatment) are also listed as “useful in certain circumstances” for these patients in the NCCN Guidelines, based on supportive data from recent studies.
Other recent updates regarding differentiated thyroid cancer include the following:
- Encompassing the abovementioned and other revisions, the section for systemic therapy has been modified.
- The algorithms for the diagnosis as well as the primary treatment of papillary and oncocytic carcinoma have been modified.
- Modifications were made to the algorithms for the management of follicular and papillary carcinomas after total thyroidectomy with radioactive iodine, as well as to the algorithms for the treatment of locally recurrent, advanced, and/or metastatic radioactive iodine–refractory disease.
Resectable Gastroesophageal Adenocarcinoma and Peritoneal-Limited Disease
“It is a very exciting time for developing new treatments in gastric cancer.”
—Harry H. Yoon, MD, MHS
Based largely on recently published data from the ESOPEC trial, perioperative chemotherapy with FLOT (fluorouracil plus leucovorin, oxaliplatin, and docetaxel) became the new “preferred” primary treatment for medically fit patients with resectable locally advanced esophageal and esophagogastric junction adenocarcinomas, replacing the previous standard of preoperative chemoradiation therapy. This represents the “biggest change this year in the [NCCN Guidelines for Esophageal and Esophagogastric Junction Cancers] for this indication,” according to Harry H. Yoon, MD, MHS, of the Mayo Clinic Comprehensive Cancer Center, Rochester, Minnesota.
Harry H. Yoon, MD, MHS
Although preoperative chemoradiation therapy is no longer “preferred” and has been downgraded to category 2A (from category 1), deciding when to use this previous standard is “complicated” and requires multidisciplinary discussion, according to Dr. Yoon. A footnote was thus added, providing criteria that essentially support preoperative chemoradiation therapy for those who likely would have been excluded from the ESOPEC trial.
An algorithm for the treatment of peritoneal-limited disease was introduced in the first version of the 2024 NCCN Guidelines for Gastric Cancer, recommending cytoreductive surgery with gastrectomy and intraperitoneal chemotherapy/hyperthermic intraperitoneal chemotherapy (HIPEC)/pressurized intraperitoneal aerosol chemotherapy as an additional treatment in patients with a low peritoneal cancer index (defined as ≤ 10) and stable or improved disease after at least 6 months of systemic therapy and a multidisciplinary discussion. In a subsequent version, the recommendation was updated to require a minimum of 3 months of systemic therapy, swap the order of the surgical procedures, and remove pressurized intraperitoneal aerosol chemotherapy; data supporting the use of this drug delivery system are limited, so it is now recommended only in the context of a clinical trial.
“[The abovementioned recommended additional treatment regimen] should only be done at institutions with considerable experience with gastrectomy, cytoreduction, and HIPEC,” commented Travis E. Grotz, MD, MS, also of the Mayo Clinic Comprehensive Cancer Center, after presenting the updates.
Advanced Gastroenteropancreatic Neuroendocrine Tumors
“In terms of therapies, we have a number of new tools in the toolkit.”
—Emily Bergsland, MD
Emily Bergsland, MD
Emily Bergsland, MD, of the University of California, San Francisco (UCSF) Helen Diller Family Comprehensive Cancer Center, discussed the consequential updates to the NCCN Guidelines for well-differentiated advanced gastroenteropancreatic neuroendocrine tumors resulting from influential clinical trials.
Cabozantinib, which is now FDA-approved based on the CABINET trial, was recently added to the NCCN Guidelines for the following clinical scenarios:
- Treatment of well-differentiated locoregionally advanced and/or distant metastatic grade 1 or 2 neuroendocrine tumors of the gastrointestinal tract (preferred; category 1 if previously treated with everolimus or lutetium Lu-177 dotatate);
- Treatment of well-differentiated locoregionally advanced and/or distant metastatic grade 1 or 2 pancreatic neuroendocrine tumors (preferred; category 1 if previously treated with everolimus, lutetium Lu-177 dotatate, or sunitinib);
- Treatment of well-differentiated locally advanced or metastatic (unresectable with clinically significant tumor burden or evidence of disease progression) grade 3 neuroendocrine tumors with favorable biology.
Findings from the NETTER-1 trial supported the initial FDA approval of peptide receptor radionuclide therapy with lutetium Lu-177 dotatate for progressive gastroenteropancreatic neuroendocrine tumors after somatostatin analog therapy. Building on this, NETTER-2 evaluated its use as a first-line treatment in patients with higher-risk tumors, leading to its inclusion in the NCCN Guidelines in the following clinical scenarios:
- First-line treatment of well-differentiated locoregionally advanced and/or distant metastatic grade 1 or 2 somatostatin receptor (SSTR)-positive neuroendocrine tumors of the gastrointestinal tract and pancreas (if the Ki67 index is ≥ 10% and there is a clinically significant tumor burden; preferred);
- Treatment of well-differentiated locally advanced or metastatic grade 3 SSTR-positive neuroendocrine tumors with favorable biology (eg, Ki67 index < 55%) (if unresectable with a clinically significant tumor burden or evidence of disease progression) (category 2B).
“There have been changes to pathological classification over the past 8 years or so, with well-differentiated grade 3 neuroendocrine tumors added for tumors arising in the pancreas in 2017 and the gastrointestinal tract in 2019, which then led to a new section of the Guidelines [and subsequent revisions to it (abovementioned)] to address management of this new group of tumors,” Dr. Bergsland told The ASCO Post. “This is an evolving area, as new studies are starting to emerge that specifically include this group.”
Metastatic Colorectal Cancer
“[In this era, we have] a range of treatment options that have changed the face of [advanced and metastatic colorectal cancer].”
—Alan P. Venook, MD
Alan P. Venook, MD
Alan P. Venook, MD, of the UCSF Helen Diller Family Comprehensive Cancer Center, highlighted two recent “game-changing” updates to the systemic therapy landscape for metastatic colorectal cancer that are now reflected in the NCCN Guidelines. Both are supported by clinical trial data presented during the 2025 ASCO Gastrointestinal Cancers Symposium.
CheckMate 8HW: The recommendation for nivolumab plus ipilimumab in microsatellite instability–high (MSI-H)/mismatch repair–deficient (dMMR) disease has expanded to include first-line treatment (category 2A), with category 2B status in cases where intensive therapy is not advised because of toxicity concerns.
BREAKWATER: Encorafenib plus cetuximab and FOLFOX (leucovorin, fluorouracil, and oxaliplatin) is now recommended as an initial intensive therapy (category 2A) and as a second-line and subsequent biomarker-directed therapy (category 2B) for patients with advanced or metastatic BRAF V600E–mutated microsatellite stable (MSS)/mismatch repair–proficient (pMMR) (or MSI-H/dMMR or POLE/POLD1 mutation–positive with an ultra-hypermutated phenotype that is ineligible for or progressed on checkpoint inhibitor immunotherapy) disease. Of note, although panitumumab was not evaluated in the trial, it is listed as an alternative to cetuximab.
Other recent updates to the systemic therapy landscape include the following additions:
- Nivolumab plus ipilimumab for colorectal cancer (MSI-H/dMMR or POLE/POLD1-mutated with an ultra-hypermutated phenotype; if checkpoint inhibitor monotherapy was previously received);
- Additional checkpoint immunotherapy options (ie, cemiplimab-rwlc, retifanlimab-dlwr, toripalimab-tpzi, tislelizumab-jsgr) for patients with MSI-H/dMMR or POLE/POLD1 mutations with an ultra-hypermutated phenotype in the following clinical scenarios:
—Neoadjuvant treatment for rectal cancer with resectable synchronous liver only and/or lung only metastases;
—Initial treatment of immunotherapy-naive rectal cancer with resectable metachronous metastases;
—Any line of treatment for immunotherapy-eligible, immunotherapy-naive colorectal cancer, with the option for continuation following disease status reassessment;
- FOLFIRINOX (leucovorin, fluorouracil, irinotecan, and oxaliplatin) as a neoadjuvant chemotherapy option for MSS/pMMR rectal cancer with resectable synchronous liver only and/or lung only metastases.
A recent update in surgical and locoregional management emerged from the COLLISION trial of colorectal cancer liver metastases. Per the NCCN Guidelines, thermal ablation is equivalent to resection for the treatment of select small-sized lesions (≤ 3 cm).
Dihydropyrimidine dehydrogenase (DPYD) catabolizes fluoropyrimidines, and genetic variants that alter its enzymatic activity may increase the risk of toxicity for patients treated with these drugs. This pharmacogenetic phenomenon is recognized by the NCCN Guidelines for colorectal cancer, which now recommend discussing DPYD genetic variant testing prior to fluoropyrimidine therapy and considering it in the context of the patient’s individual circumstances.
Small Cell Lung Cancer
“The pace of progress was quite slow initially with small cell lung cancer…. [But] in 2024, we have had two exciting developments….”
—Saiama N. Waqar, MD, MSCI
Saiama N. Waqar, MD, MSCI
The key updates to the NCCN Guidelines for Small Cell Lung Cancer were centered on the further integration of immunotherapy into the treatment paradigm, according to Saiama N. Waqar, MD, MSCI, of Washington University School of Medicine, St. Louis.
Supported by the DeLLphi-301 trial, tarlatamab-dlle was added as a subsequent therapy option for patients with a chemotherapy-free interval of more than (other recommended) and up to (preferred) 6 months.
Consolidation therapy with durvalumab was added as a “preferred” regimen for patients with limited-stage disease who did not experience disease progression after systemic therapy plus concurrent radiation therapy, informed by the ADRIATIC trial, with a subsequent change in its NCCN Category of Recommendation (category 1 from 2A) designation.
Nonmetastatic NSCLC
“I urge everybody to discuss these cases in your multidisciplinary tumor board…[and to] get good molecular testing….”
—Jonathan W. Riess, MD, MS
Patients with tumors of at least 4 cm or node-positive non–small cell lung cancer (NSCLC) who do not have actionable oncogene driver mutations such as EGFR mutations and ALK fusions should be evaluated for preoperative therapy, with a strong consideration for the combination of immune checkpoint inhibitors plus chemotherapy, per the updated NCCN Guidelines. Jonathan W. Riess, MD, MS, of the University of California (UC) Davis Comprehensive Cancer Center, Sacramento, discussed two trials of immunotherapy before and after surgery, combined with preoperative chemotherapy, that informed some of the most recent additions to the Guidelines: AEGEAN (durvalumab; category 1) and CheckMate 77T (nivolumab; category 1). Of note, based on the ALINA trial, adjuvant alectinib is now recommended for ALK-positive disease (category 1).
Jonathan W. Riess, MD, MS
Based on the LAURA trial, osimertinib is now listed as a consolidation therapy option for patients with unresectable stage II or III NSCLC, an Eastern Cooperative Oncology Group performance status score of 0 or 1, and no disease progression after definitive concurrent chemoradiation therapy; category 1 for stage III, category 2A for stage II.
Relapsed or Refractory Hodgkin Lymphoma
“The benefits of checkpoint inhibitors do appear to persist beyond [disease] progression.”
—Ryan C. Lynch, MD
Primary treatment with nivolumab plus AVD (doxorubicin, vinblastine, and dacarbazine) was recently promoted to “preferred” (from “other recommended”) status and category 1 (from 2A) for stage III to IV classical Hodgkin lymphoma, and it was added in combination with involved-site radiation therapy for stage I or II unfavorable disease in the NCCN Guideline. Ryan C. Lynch, MD, of Fred Hutchinson Cancer Center and the University of Washington School of Medicine, Seattle, emphasized the importance of exploring the next steps when front-line immunotherapies fail.
Ryan C. Lynch, MD
The recommendations for systemic therapy for relapsed or refractory disease have been updated in the latest version of the Guidelines, with PD-1 inhibitors serving as the current “backbone” of management. Essentially, the revised approach emphasizes that, “if a checkpoint inhibitor hasn’t been given upfront, it should be part of the second-line regimen,” according to Dr. Lynch.
In a discussion with The ASCO Post, he outlined the key modifications to the treatment algorithms regarding immune checkpoint inhibitor–based second-line therapy:
- For high-dose therapy/autologous stem cell rescue–eligible patients with primary refractory disease or relapse within 3 months, such therapy is now “preferred” in the absence of prior exposure to immune checkpoint inhibitors.
- High-dose therapy/autologous stem cell rescue–ineligible patients who underwent immune checkpoint inhibitor therapy and experienced disease progression at least 3 (vs 6) months after their last exposure are now eligible.
This year also brought three key modifications to NCCN’s recommendations for patients who are refractory to at least three prior lines of subsequent therapy, Dr. Lynch told The ASCO Post. Despite concerns over durability, two pembrolizumab-containing doublet regimens (with vorinostat or decitabine) were added, given the limited options in this setting. Involved-site radiation therapy is now also recommended.
Multiple Myeloma
“We have made dramatic progress in the management of multiple myeloma.”
—Shaji K. Kumar, MD
Shaji K. Kumar, MD, of the Mayo Clinic Comprehensive Cancer Center, Rochester, Minnesota, and Natalie S. Callander, MD, of the University of Wisconsin and William S. Middleton Memorial Veterans’ Hospital, Madison, presented recent data in multiple myeloma, which have contributed in part to changes in the recommendations within the NCCN Guidelines over the past year.
Shaji K. Kumar, MD
Natalie S. Callander, MD
Recent changes indicate a shift toward quadruplet therapies in the management of transplant candidates. The combination of daratumumab, lenalidomide, bortezomib, and dexamethasone (category 1) has been promoted from an “other recommended” to “preferred” primary therapy for these patients, whereas two triplets (bortezomib, lenalidomide, and dexamethasone [category 1] and carfilzomib, lenalidomide, and dexamethasone) are now classified as “other recommended.” Another recent addition to the list of “other recommended” regimens is isatuximab-irfc, bortezomib, lenalidomide, and dexamethasone.
Updates to the maintenance therapy recommendations for this population include the following:
- Lenalidomide with carfilzomib or daratumumab are now classified as “other recommended” regimens.
- Still considered “useful in certain circumstances,” the recommendation for bortezomib plus lenalidomide was modified to bortezomib with or without lenalidomide.
Similarly, quadruplet regimens are emerging as primary therapies for nontransplant candidates. The regimen of isatuximab, bortezomib, lenalidomide, and dexamethasone was recently added as a “preferred” option for nonfrail patients younger than age 80 (category 1). Here are other updates in primary therapy for the transplant-ineligible population:
The regimens of daratumumab, bortezomib, melphalan, and prednisone (category 1) and daratumumab, cyclophosphamide, bortezomib, and dexamethasone have been removed as “other recommended” regimens; the latter is now classified as “useful in certain circumstances.”
The regimen isatuximab, carfilzomib, lenalidomide, and dexamethasone was added as “useful in certain circumstances” (category 2B).
A new column was recently added to the table of “preferred” regimens for previously treated patients (one to three prior lines), which includes the following recommendations for those whose disease is refractory to anti-CD38 agents:
- Carfilzomib, lenalidomide, and dexamethasone (category 1);
- Carfilzomib, pomalidomide, and dexamethasone;
- Pomalidomide, bortezomib, and dexamethasone (category 1);
- Elotuzumab, pomalidomide, and dexamethasone (after two prior therapies, including lenalidomide and a proteasome inhibitor);
- Ixazomib, pomalidomide, and dexamethasone (after two prior therapies, including an immunomodulatory drug and a proteasome inhibitor, and with disease progression on/within 60 days of completion of the last therapy).
The bortezomib-refractory column now includes elotuzumab, pomalidomide, and dexamethasone, recommended after two prior therapies, including lenalidomide and a proteasome inhibitor. In the lenalidomide-refractory column, the abovementioned regimen was moved under a heading to reflect this indication, and the regimen of selinexor, bortezomib, and dexamethasone (category 1) was removed and reclassified to “other recommended.”
Further updates to the list of “other recommended” options after one to three prior lines of therapy include the addition of daratumumab, carfilzomib, pomalidomide, and dexamethasone. Another option in this category—pomalidomide, cyclophosphamide, and dexamethasone—was recently promoted to category 1 (from 2A; after two prior therapies, including an immunomodulatory drug and a proteasome inhibitor, and disease progression on or within 60 days of completion of the last therapy).
Anti–B-cell maturation antigen and anti–G protein–coupled receptor, class C group 5 member D bispecific antibodies are now key treatment options for heavily pretreated patients, according to the presenters. Thus, talquetamab-tgvs and teclistamab-cqyv are now listed in the NCCN Guidelines as “useful in certain circumstances” for those who underwent at least three prior lines of therapy.
DISCLOSURE: Dr. Flaig has received consulting fees from Criterium; has received grant or research support from Agensys, Astellas Pharma US, AstraZeneca, Bristol Myers Squibb, Genentech, Janssen Pharmaceutica Products, Merck & Co., sanofi-aventis U.S., and SeaGen; has disclosed intellectual property rights and equity interest or stock options with Aurora Oncology; and has served as a scientific advisor for Criterium and Janssen Pharmaceutica Products. Dr. Spiess has served as a consultant to MyCareAlgorithm in developing educational resources for patients and health-care providers. Dr. Wirth has received consulting fees from AbbVie, Bayer HealthCare, Bicara Therapeutics, Coherus BioSciences, Eisai, Eli Lilly and Company, EMD Serono, Exelixis, Illumina, Merck & Co., Nested Therapeutics, PDS Biotechnology, Replimune Group, and Tubulis GmbH; and has served as a scientific advisor for Eisai, Eli Lilly and Company, and Ellipses Pharma. Dr. Yoon has received grant or research support from Amgen, BeiGene, Bristol Myers Squibb, and Merck & Co.; has received honoraria from Amgen, Astellas Pharma US, BeiGene, Elevation Oncology, and Merck & Co.; and has served as a scientific advisor for Amgen, Astellas Pharma US, BeiGene, Elevation Oncology, and Merck & Co. Dr. Grotz has received consulting fees from Agenus and Ferranova. Dr. Bergsland has received grant or research support from Boehringer Ingelheim GmbH, Merck & Co., and RAYZbio. Dr. Venook has served as a scientific advisor for Amgen, Bristol Myers Squibb, Exact Sciences Corporation, Exelixis, GSK, Intera Oncology, and Pfizer. Dr. Waqar has received consulting fees from AstraZeneca, Boehringer Ingelheim GmbH, Daiichi Sankyo, Gilead Sciences, Janssen Pharmaceuticals, Amgen, and Pfizer; and has received institutional grant or research support from AbbVie, Advenchen Laboratories, AstraZeneca, Elevation Oncology, Nuvalent, Genentech, Gilead Sciences, Janssen Pharmaceuticals, Regeneron Pharmaceuticals, Ribon Therapeutics, and Takeda Pharmaceuticals North America. Dr. Riess has received consulting fees from Daiichi Sankyo and OncoHost; has received grant or research support from ArriVent BioPharma, AstraZeneca, Boehringer Ingelheim GmbH, IO Biotech, Merck & Co., Novartis, Nuvalent, Prelude Therapeutics, Revolution Medicines, SeaGen, and Summit Therapeutics; and has received honoraria from Amgen, Bristol Myers Squibb, Catalyst Pharmaceuticals, Genentech, GSK, Janssen Pharmaceutica Products, Merck & Co., Merus N.V., Pfizer, and Regeneron Pharmaceuticals. Dr. Lynch has received consulting fees from AbbVie, ADC Therapeutics SA, and Janssen Pharmaceutica Products; has received grant or research support from Allogene Therapeutics, Cyteir Therapeutics, Genentech, Incyte, Janssen Pharmaceutica Products, Pfizer, and RAPT Therapeutics; and has received honoraria from Merck & Co. Dr. Kumar has received consulting fees from Moderna; has received grant or research support from AbbVie, Amgen, Bristol Myers Squibb, CARsgen Therapeutics, GSK, Janssen Pharmaceutica Products, Oricell Therapeutics, Regeneron Pharmaceuticals, Roche Laboratories, sanofi-aventis U.S., and Takeda Pharmaceuticals North America; and has served as a scientific advisor for AbbVie, Amgen, Bristol Myers Squibb, GSK, Janssen Pharmaceutica Products, Regeneron Pharmaceuticals, Roche Laboratories, sanofi-aventis U.S., and Takeda Pharmaceuticals North America. Dr. Callander reported no conflicts of interest.
