What NCCN’s next CMO sees ahead for cancer guidelines, access and innovation

Renuka Iyer, M.D., a distinguished oncologist from Roswell Park Comprehensive Cancer Center, was appointed Chief Medical Officer (CMO) of the National Comprehensive Cancer Network (NCCN) earlier this month. She will officially assume the role on February 26, 2026, bringing decades of expertise in gastrointestinal oncology, rare cancers and guideline development to the organization’s mission of advancing evidence-based cancer care.

In an interview with Managed Healthcare Executive (MHE), Iyer discussed how NCCN can continue to deliver evidence-based, high-value oncology care in a rapidly changing treatment landscape.

The below Q&A has been edited for clarity.

MHE: NCCN Guidelines are considered the gold standard in oncology care. As CMO, how do you envision evolving these guidelines to address both clinical innovation and payer realities in value-based care?

Iyer: As incoming CMO, I look forward to helping maintain the current level of excellence for the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) Program. Independent studies find NCCN Guidelines-adherent care to be associated with better outcomes, longer survival and lower cost. Moving forward, we can continue to explore ways to improve point-of-care access, such as through the NCCN Guidelines Navigator and other collaborations with HIT organizations. But it is important that we keep the human touch while leveraging emerging technology.

I also want to highlight the important role of supportive care tools, such as the NCCN Distress Thermometer. This resource facilitates a holistic, "person-in-environment" model of care that extends beyond purely physical symptoms. That leads to innovative integrated care pathways that combine medical treatment with psychosocial, practical and financial support. As CMO, I would like to find ways to further increase its use and streamline access to supportive services for timely interventions that deliver high-value care.

MHE: You’ve been deeply involved in hepatobiliary and rare cancers. How will your experience in rare disease research shape NCCN’s approach to guideline development for underrepresented patient populations?

Iyer: As of late 2024/early 2025, the FDA has approved around 8 to 10 tumor-agnostic therapies (drugs or drug combinations) for specific molecular alterations (biomarkers), including NTRK fusions, MSI-H/dMMR, TMB-High, BRAF V600E mutations, RET fusions and HER2 positivity, targeting various solid tumors, with approvals starting in 2017.

These represent key shifts in precision oncology, focusing on the genetic makeup of the cancer rather than its tissue of origin. Personally, seeing these approvals listed in all appropriate NCCN Guidelines and the NCCN Biomarkers Compendium, providing guidance to ensure proper testing is done, has been valuable and given me hope for the future of our rare cancer patients.

The NCCN Guidelines cover 97% of the cancers diagnosed in the U.S. every year, plus prevention, screening, and supportive care, so any new NCCN Guidelines that publish are focused on very rare cancers. For example, in the past year NCCN added new guidelines for ampullary adenocarcinoma as part of the commitment to expand resources in the rare cancer space. NCCN is also focusing on expanding the library of NCCN Guidelines focused on pediatric cancers, which are thankfully very rare.

MHE: What do you see as the biggest challenge in balancing rapid innovation in oncology (e.g., immunotherapy, biomarkers, ADCs) with the need for evidence-based, consensus-driven guidelines?

Iyer: The biggest challenge is making sure innovations are accessible for all; to transform what is currently an option for some into options for the sum of cancer patients.

NCCN Guidelines are a tool to help busy practitioners keep up with rapid innovation by providing expert consensus-driven recommendations based on the latest research and approvals. The NCCN Guidelines in Practice™ are another tool to help—allowing busy providers to earn certification credit hours while accessing the NCCN Guidelines to determine optimal courses of action for the individual patient in front of them.

MHE: How do you plan to expand NCCN’s global footprint, ensuring guidelines are adaptable to diverse healthcare systems with varying resources?

Iyer: NCCN has ongoing work with organizations based in various countries and regions to adapt the NCCN Guidelines for local factors, including in Asia, Africa, Europe, and South America. The NCCN Framework for Resource Stratification of NCCN Guidelines (NCCN Framework) is one example of a tool for different resource levels. It provides color-coded, tiered options to stratify across differing resources, providing both pragmatic and aspirational recommendations that optimize current care and improve future care. I look forward to expanding this work in the future, collaborating with more organizations in additional countries or regions.

MHE: Real-world evidence and digital health tools are increasingly influencing payer and clinical decisions. How will NCCN incorporate these data sources into guideline updates?

Iyer: NCCN Guidelines panels utilize the best available evidence to base their recommendations. There may be instances where prospective evidence is lacking, and real-world evidence can fill a void or provide some assurance for efficacy beyond what is available in clinical trials; that will be reviewed during guideline panel meetings.

Most digital health tools were designed as an adjunct to clinical visits and a way to have some objective, timely communication to allow triage and appropriate referrals. They have the potential to reduce the burden of travel on patients and families when integrated and used as designed. The relevant supportive care guideline panels evaluate this prospective evidence for inclusion where appropriate.

MHE: What innovations in point-of-care tools do you envision to make guidelines more actionable for clinicians and payers alike? You've described this as a pivotal time for oncology.

Iyer: The NCCN Guidelines Navigator enables providers to zero in on exactly the recommendations that best fit the needs of each specific patient, while filtering out irrelevant additional information.

Features include:

• Move seamlessly through the NCCN Guideline using the table of contents or search features
• Select answers in nodes to highlight relevant NCCN Guidelines paths
• Sections of the NCCN Guidelines are color-coded and linked, allowing users to directly navigate to that section
• Easily view related footnotes
• Type prompts, which the search function will auto-complete and select filters to highlight content of interest
• Access the related NCCN Chemotherapy Order Templates (NCCN Templates) via the ID number
• Zoom out to see the whole algorithm
• View a tutorial and FAQ when needed

MHE: What personal experiences or lessons from your 21 years in academic oncology will guide your leadership at NCCN?

Iyer: I spent much of my career focusing on novel therapies for hepatocellular cancer, cholangiocarcinoma, and neuroendocrine cancer. While we have come a long way in 21 years, early detection and cure are still only a reality for a handful, underscoring the important work that remains to be done. The common lesson I learned from treating these cancers was the importance of teamwork and mentoring the next generation to continue the work. For HCC, until 2017, there was just one drug, sorafenib, and in the last 10 years we have had about 10 more drugs and drug combinations approved, but roughly 40% of patients never get treated.

So, after 21 years where my work was deep but focused, I am now hoping to devote this next part of my career to doing work that will impact a much broader population. I plan to leverage the relationships I have built to advocate for any who have been left behind.