Guidelines: who agrees with whom
21 clinically important settings compared across NCCN, ESMO, NICE and ASCO: 15 where every body agrees, 5 where at least one restricts or rejects what another prefers. Below, 69 dated guideline versions across 19 cancers list 122 changes: what was added, removed or moved.
Concordance
21 of 21 settings
| Setting and intervention | NCCN | ESMO | NICE | ASCO | Verdict |
|---|---|---|---|---|---|
Triple-negative breast cancer (TNBC) · Stage II-III, neoadjuvant Pembrolizumab with chemotherapy before surgery, continued after (KEYNOTE-522) | Preferred Category 1, preferred 2021-07 | Recommended I, A; ESMO-MCBS A 2024-02 | Recommended TA851 2022-12 | · | Bodies agree |
HR-positive / HER2-negative breast cancer · Metastatic, HER2-low, after chemotherapy Trastuzumab deruxtecan for HER2-low metastatic breast cancer after one chemotherapy (DESTINY-Breast04) | Preferred Category 1, preferred 2022-08 | Recommended I, A; ESMO-MCBS 4 2023 | Not recommended 2024 | Recommended 2023 | Bodies disagree |
HER2-positive breast cancer · Metastatic, second line Trastuzumab deruxtecan after trastuzumab and a taxane (DESTINY-Breast03) | Preferred Category 1, preferred 2022-05 | Recommended I, A; ESMO-MCBS 4 2023 | Recommended TA862 2023-02 | Recommended 2022 | Bodies agree |
HER2-positive breast cancer · Metastatic, later lines and brain metastases Tucatinib with trastuzumab and capecitabine (HER2CLIMB) | Recommended Category 1 (third line) 2020-04 | Recommended I, A; ESMO-MCBS 4 2023 | Restricted TA786 2022-04 | · | Bodies disagree |
HR-positive / HER2-negative breast cancer · Adjuvant, high risk Abemaciclib for 2 years with endocrine therapy (monarchE) | Recommended Category 1 2021-10 | Recommended I, A; ESMO-MCBS A 2024-02 | Recommended TA810 2022-07 | Recommended 2022 | Bodies agree |
Triple-negative breast cancer (TNBC) · Adjuvant, germline BRCA, high risk Olaparib for one year after chemotherapy (OlympiA) | Recommended Category 1 2022-03 | Recommended I, A; ESMO-MCBS A 2024-02 | Recommended TA886 2023-06 | · | Bodies agree |
Non-small-cell lung cancer · Metastatic, EGFR-mutant, first line Osimertinib first line (FLAURA) | Preferred Category 1, preferred 2018-04 | Recommended I, A; ESMO-MCBS 4 2023 | Recommended TA654 2020-10 | Recommended 2022 | Bodies agree |
Non-small-cell lung cancer · Adjuvant, EGFR-mutant, stage IB-IIIA Osimertinib for 3 years after resection (ADAURA) | Recommended Category 1 2020-12 | Recommended I, A; ESMO-MCBS A 2023 | Recommended TA761 2022-01 | Recommended 2022 | Bodies agree |
Non-small-cell lung cancer · Stage III unresectable, after chemoradiation Durvalumab consolidation for 12 months (PACIFIC) | Recommended Category 1 2018 | Restricted I, A (PD-L1 1% or above); ESMO-MCBS A 2023 | Restricted TA798 (after CDF entry as TA578, 2019) 2022-05 | Recommended 2022 | Bodies disagree |
Renal cell carcinoma · Untreated advanced clear-cell, intermediate or poor risk Nivolumab plus ipilimumab (CheckMate 214) | Preferred Category 1, preferred 2018-04 | Recommended I, A; ESMO-MCBS 4 2021 | Recommended TA780 2022-04 | Recommended 2022 | Bodies agree |
Renal cell carcinoma · Untreated advanced clear-cell, any risk Pembrolizumab plus axitinib (KEYNOTE-426) | Preferred Category 1, preferred 2019-04 | Recommended I, A; ESMO-MCBS 4 2021 | Recommended TA650 2020-09 | Recommended 2022 | Bodies agree |
Colorectal cancer · Metastatic, MSI-high / dMMR, first line Pembrolizumab monotherapy (KEYNOTE-177) | Preferred Category 1, preferred 2020-06 | Recommended I, A; ESMO-MCBS 4 2023-01 | Recommended TA709 2021-07 | · | Bodies agree |
Bladder & urothelial cancer · Metastatic, first line Enfortumab vedotin plus pembrolizumab (EV-302) | Preferred Category 1, preferred 2024-03 | Recommended I, A; ESMO-MCBS 4 2024 | Recommended 2024 | · | Bodies agree |
Oesophageal cancer · Adjuvant after chemoradiation, residual disease Nivolumab for one year after neoadjuvant chemoradiation and surgery with residual disease (CheckMate 577) | Recommended Category 1 2021-05 | Recommended I, A 2022 | Recommended TA746 2021-11 | · | Bodies agree |
Ovarian cancer · Newly diagnosed, BRCA-mutated, maintenance Olaparib maintenance for 2 years after platinum response (SOLO-1) | Recommended Category 1 2018-12 | Recommended I, A 2023-10 | Restricted TA598 2019-07 | Recommended 2020 | Bodies disagree |
Melanoma · Unresectable or metastatic, BRAF V600-mutant, first line Immunotherapy before BRAF/MEK inhibition (DREAMseq) | Preferred Category 1, preferred 2023 | Recommended I, A 2024 | · | Recommended 2023 | Bodies agree |
Chronic lymphocytic leukaemia · Untreated, del(17p) or TP53-mutated Targeted therapy (BTK inhibitor or venetoclax-obinutuzumab) instead of chemoimmunotherapy | Preferred Category 1, preferred 2023 | Recommended I, A 2021-01 | Recommended TA689; TA663 2021-05 | · | Bodies agree |
Hepatocellular carcinoma · Unresectable, first line Atezolizumab plus bevacizumab (IMbrave150) | Preferred Category 1, preferred 2020-06 | Recommended I, A; ESMO-MCBS 4 2021 | Recommended TA666 2020-12 | · | Bodies agree |
Gastric & gastro-oesophageal junction cancer · Metastatic, HER2-negative, first line Nivolumab with fluoropyrimidine-platinum chemotherapy (CheckMate 649) | Recommended Category 1 (CPS 5 or above); 2B (CPS 1-4) 2021-04 | Restricted I, A; ESMO-MCBS 4 (CPS 5 or above) 2022-10 | Restricted TA857 2023-02 | · | Bodies disagree |
Endometrial cancer · Advanced or recurrent, dMMR, first line Dostarlimab with carboplatin-paclitaxel (RUBY) | Preferred Category 1, preferred 2023-07 | Recommended I, A 2024 | Recommended 2024 | · | Bodies agree |
Prostate cancer · Metastatic castration-resistant, PSMA PET-positive 177Lu-PSMA-617 (VISION, PSMAfore) | Recommended Category 1 2022-03 | Recommended I, A; ESMO-MCBS 4 2024 | Not appraised 2023 | · | Partly appraised |
Why bodies disagree
NCCN and ESMO judge efficacy and safety; NICE also judges cost-effectiveness for the NHS, so a drug can be category 1 in the US and unfunded in England. ESMO and NICE follow the EMA licence, which is sometimes narrower than the FDA label (PD-L1 thresholds are the usual example). ASCO issues rapid updates after pivotal trials and rarely restricts.
Bodies covered
- NCCN (United States): National Comprehensive Cancer Network.
- ESMO (Europe): European Society for Medical Oncology Clinical Practice Guidelines.
- NICE (England and Wales): National Institute for Health and Care Excellence technology appraisals decide whether the NHS in England must fund a treatment, on cost-effectiveness as well as efficacy.
- ASCO (United States): American Society of Clinical Oncology guidelines and rapid recommendation updates, evidence-based with strength of recommendation stated..
CSCO (China) and JSMO (Japan) slots exist in the data and are open for contributions.
Version history by cancer
Acute myeloid leukaemia
4 versions, 8 changes, 2017-2025
Bladder & urothelial cancer
4 versions, 8 changes, 2020-2025 · 1 concordance row
Cervical cancer
2 versions, 4 changes, 2021-2024
Chronic lymphocytic leukaemia
4 versions, 8 changes, 2019-2024 · 1 concordance row
Colorectal cancer
4 versions, 9 changes, 2020-2025 · 1 concordance row
Diffuse large B-cell lymphoma
3 versions, 5 changes, 2019-2023
Endometrial cancer
2 versions, 3 changes, 2021-2024 · 1 concordance row
Gastric & gastro-oesophageal junction cancer
3 versions, 6 changes, 2021-2024 · 1 concordance row
Hepatocellular carcinoma
No version history yet · 1 concordance row
HER2-positive breast cancer
6 versions, 7 changes, 2013-2026 · 2 concordance rows
HR-positive / HER2-negative breast cancer
6 versions, 10 changes, 2017-2025 · 2 concordance rows
Melanoma
5 versions, 7 changes, 2016-2024 · 1 concordance row
Multiple myeloma
5 versions, 9 changes, 2019-2025
Non-small-cell lung cancer
6 versions, 14 changes, 2018-2025 · 3 concordance rows
Oesophageal cancer
No version history yet · 1 concordance row
Ovarian cancer
3 versions, 5 changes, 2020-2023 · 1 concordance row
Prostate cancer
5 versions, 7 changes, 2018-2025 · 1 concordance row
Renal cell carcinoma
3 versions, 4 changes, 2019-2023 · 2 concordance rows
Triple-negative breast cancer (TNBC)
4 versions, 8 changes, 2020-2024 · 2 concordance rows
Each version entry is anchored to a dated public event (approval, trial publication or guideline publication) and lists the rows added, removed or recategorised. NCCN version numbers are not reproduced unless verified; entries are dated to the month the change entered practice. The per-cancer page lets you pick two versions and see everything that changed between them.