Interpretation of updated NCCN guidelines for non-small cell lung cancer (version 3. 2018)_West China Medical Journal

Authors：

WANG Shuhang ,  WANG Jie

Medical Oncology Department, Cancer Hospital Chinese Academy of Medical Science, Beijing 100021, P. R. China;

Corresponding author：

WANG Jie, Email: zlhuxi@163.com

Keywords：

Non-small cell lung cancer; NCCN Guideline; Version 3. 2018 update

DOI：

10.7507/1002-0179.201804017

Video：

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This article interprets the version 3. 2018 of NCCN guidelines for the diagnosis and treatment of non-small cell lung cancer. Compared with the version 9. 2017 of the guidelines, the new version has been updated based on the latest evidence-based evidence, laying the emphasis on genotyping and targeted therapy, and standardizes the principles of pathological evaluation and molecular detection, systematically recommends treatment after resistance to targeted therapy, and specifies the population with driver gene alterations for immunotherapy. All of which could guide clinical practice with higher efficacy more precisely.

Citation： WANG Shuhang, WANG Jie. Interpretation of updated NCCN guidelines for non-small cell lung cancer (version 3. 2018). West China Medical Journal, 2018, 33(4): 388-392. doi: 10.7507/1002-0179.201804017 Copy

1.	Macmahon H, Naidich DP, Goo JM, et al. Guidelines for management of incidental pulmonary nodules detected on CT images: from the fleischner society 2017. Radiology, 2017(284): 161659.
2.	Travis WD, Brambilla E, Nicholson AG, et al. The 2015 World Health Organization classification of lung tumors: impact of genetic, clinical and radiologic advances since the 2004 classification. J Thorac Oncol, 2015, 10(9): 1243-1260.
3.	Aziz N, Zhao Q, Bry L, et al. College of American pathologists’ laboratory standards for next-generation sequencing clinical tests. Arch Pathol Lab Med, 2015, 139(4): 481-493.
4.	Ghattas MA, Raslan N, Sadeq A, et al. Druggability analysis and classification of protein tyrosine phosphatase active sites. Drug Des Devel Ther, 2016, 10(10): 3197-3209.
5.	Reck M, Rodriguez-Abreu D, Robinson AG, et al. Pembrolizumab versus chemotherapy for PD-L1-positive non-small-cell lung Cancer. N Engl J Med, 2016, 375(19): 1823-1833.
6.	Herbst RS, Baas P, Kim DW, et al. Pembrolizumab versus docetaxel for previously treated, PD-L1-positive, advanced non-small-cell lung cancer (KEYNOTE-010): a randomised controlled tria. Lancet, 2016, 387(10027): 1540-1550.
7.	Yang JC, Kim DW. Osimertinib for patients (pts) with leptomeningeal metastases (LM) from EGFR-mutant non-small cell lung cancer (NSCLC): updated results from the BLOOM study. J Clin Oncol, 2017, 35(15_Suppl): 2020.
8.	Grommes C, Oxnard GR, Kris MG, et al. " Pulsatile” high-dose weekly erlotinib for CNS metastases from EGFR mutant non-small cell lung cancer. Neuro Oncol, 2011, 13(12): 1364-1369.
9.	Borghaei H, Paz-Ares L, Horn L, et al. Nivolumab versus docetaxel in advanced nonsquamous non-small-cell lung cancer. N Engl J Med, 2015, 373(17): 1627-1639.
10.	Brahmer J, Reckamp KL, Baas P, et al. Nivolumab versus docetaxel in advanced squamous-cell non-small-cell lung cancer. N Engl J Med, 2015, 373(2): 123-135.
11.	Gainor JF, Shaw AT, Sequist LV, et al. EGFR mutations andALK rearrangements are associated with low response rates to PD-1 pathway blockade in non-small cell lung cancer: a retrospective analysis. Clin Cancer Res, 2016, 22(18): 4585-4593.
12.	Kim DW, Tiseo M, Ahn MJ, et al. Brigatinib in patients with crizotinib-refractory anaplastic lymphoma kinase-positive non-small-cell lung cancer: a randomized, multicenter phase Ⅱ trial. J Clin Oncol, 2017, 35(22): 2490-2498.
13.	Kuriyama Y, Kim YH, Nagai H, et al. Disease flare after discontinuation of crizotinib in anaplastic lymphoma kinase-positive lung cancer. Case Rep Oncol, 2013, 6(2): 430-433.
14.	Pop O, Pirvu A, Toffart AC, et al. Disease flare after treatment discontinuation in a patient with EML4-ALK lung cancer and acquired resistance to crizotinib. J Thorac Oncol, 2012, 7(8): e1-e2.
15.	Shaw AT, Ou SH, Bang YJ, et al. Crizotinib in ROS1-rearranged non-small-cell lung cancer. N Engl J Med, 2014, 371(21): 1963-1971.
16.	Lim SM, Kim HR, Lee JS, et al. Open-label, multicenter, phase Ⅱ study of ceritinib in patients with non-small-cell lung cancer harboring ROS1 rearrangement. J Clin Oncol, 2017, 35(23): 2613-2618.
17.	Li BT, Shen RL, Buonocore D, et al. Ado-trastuzumab emtansine in patients with HER2 mutant lung cancers: results from a phase Ⅱ basket trial. J Clin Oncol, 2017, 35(15_Suppl): 8510.
18.	Peters S, Camidge DR, Shaw AT, et al. Alectinib versus crizotinib in untreated ALK-positive non-small-cell lung cancer. N Engl J Med, 2017, 377(9): 829-838.
19.	Soria JC, Tan DSW, Chiari R, et al. First-line ceritinib versus platinum-based chemotherapy in advanced ALK-rearranged non-small-cell lung cancer (ASCEND-4): a randomised, open-label, phase 3 study. Lancet, 2017, 389(10072): 917-929.
20.	Planchard D, Smit EF, Groen HJM, et al. Dabrafenib plus trametinib in patients with previously untreated BRAF^V600E-mutant metastatic non-small-cell lung cancer: an open-label, phase 2 trial. Lancet Oncol, 2017, 18(10): 1307-1316.
21.	Rittmeyer A, Barlesi F, Waterkamp D, et al. Atezolizumab versus docetaxel in patients with previously treated non-small-cell lung cancer (OAK): a phase 3, open-label, multicentre randomised controlled trial. Lancet, 2017, 389(166): 255-265.
22.	Ciuleanu T, Brodowicz T, Zielinski C, et al. Maintenance pemetrexed plus best supportive care versus placebo plus best supportive care for non-small-cell lung cancer: a randomised, double-blind, phase 3 study. Lancet, 2009, 374(9699): 1432-1440.
23.	Chun SG, Hu C, Choy H, et al. Impact of intensity-modulated radiation therapy technique for locally advanced non-small-cell lung cancer: a secondary analysis of the NRG oncology RTOG 0617 randomized clinical trial. J Clin Oncol, 2017, 35(1): 56-62.

1. Macmahon H, Naidich DP, Goo JM, et al. Guidelines for management of incidental pulmonary nodules detected on CT images: from the fleischner society 2017. Radiology, 2017(284): 161659.
2. Travis WD, Brambilla E, Nicholson AG, et al. The 2015 World Health Organization classification of lung tumors: impact of genetic, clinical and radiologic advances since the 2004 classification. J Thorac Oncol, 2015, 10(9): 1243-1260.
3. Aziz N, Zhao Q, Bry L, et al. College of American pathologists’ laboratory standards for next-generation sequencing clinical tests. Arch Pathol Lab Med, 2015, 139(4): 481-493.
4. Ghattas MA, Raslan N, Sadeq A, et al. Druggability analysis and classification of protein tyrosine phosphatase active sites. Drug Des Devel Ther, 2016, 10(10): 3197-3209.
5. Reck M, Rodriguez-Abreu D, Robinson AG, et al. Pembrolizumab versus chemotherapy for PD-L1-positive non-small-cell lung Cancer. N Engl J Med, 2016, 375(19): 1823-1833.
6. Herbst RS, Baas P, Kim DW, et al. Pembrolizumab versus docetaxel for previously treated, PD-L1-positive, advanced non-small-cell lung cancer (KEYNOTE-010): a randomised controlled tria. Lancet, 2016, 387(10027): 1540-1550.
7. Yang JC, Kim DW. Osimertinib for patients (pts) with leptomeningeal metastases (LM) from EGFR-mutant non-small cell lung cancer (NSCLC): updated results from the BLOOM study. J Clin Oncol, 2017, 35(15_Suppl): 2020.
8. Grommes C, Oxnard GR, Kris MG, et al. " Pulsatile” high-dose weekly erlotinib for CNS metastases from EGFR mutant non-small cell lung cancer. Neuro Oncol, 2011, 13(12): 1364-1369.
9. Borghaei H, Paz-Ares L, Horn L, et al. Nivolumab versus docetaxel in advanced nonsquamous non-small-cell lung cancer. N Engl J Med, 2015, 373(17): 1627-1639.
10. Brahmer J, Reckamp KL, Baas P, et al. Nivolumab versus docetaxel in advanced squamous-cell non-small-cell lung cancer. N Engl J Med, 2015, 373(2): 123-135.
11. Gainor JF, Shaw AT, Sequist LV, et al. EGFR mutations andALK rearrangements are associated with low response rates to PD-1 pathway blockade in non-small cell lung cancer: a retrospective analysis. Clin Cancer Res, 2016, 22(18): 4585-4593.
12. Kim DW, Tiseo M, Ahn MJ, et al. Brigatinib in patients with crizotinib-refractory anaplastic lymphoma kinase-positive non-small-cell lung cancer: a randomized, multicenter phase Ⅱ trial. J Clin Oncol, 2017, 35(22): 2490-2498.
13. Kuriyama Y, Kim YH, Nagai H, et al. Disease flare after discontinuation of crizotinib in anaplastic lymphoma kinase-positive lung cancer. Case Rep Oncol, 2013, 6(2): 430-433.
14. Pop O, Pirvu A, Toffart AC, et al. Disease flare after treatment discontinuation in a patient with EML4-ALK lung cancer and acquired resistance to crizotinib. J Thorac Oncol, 2012, 7(8): e1-e2.
15. Shaw AT, Ou SH, Bang YJ, et al. Crizotinib in ROS1-rearranged non-small-cell lung cancer. N Engl J Med, 2014, 371(21): 1963-1971.
16. Lim SM, Kim HR, Lee JS, et al. Open-label, multicenter, phase Ⅱ study of ceritinib in patients with non-small-cell lung cancer harboring ROS1 rearrangement. J Clin Oncol, 2017, 35(23): 2613-2618.
17. Li BT, Shen RL, Buonocore D, et al. Ado-trastuzumab emtansine in patients with HER2 mutant lung cancers: results from a phase Ⅱ basket trial. J Clin Oncol, 2017, 35(15_Suppl): 8510.
18. Peters S, Camidge DR, Shaw AT, et al. Alectinib versus crizotinib in untreated ALK-positive non-small-cell lung cancer. N Engl J Med, 2017, 377(9): 829-838.
19. Soria JC, Tan DSW, Chiari R, et al. First-line ceritinib versus platinum-based chemotherapy in advanced ALK-rearranged non-small-cell lung cancer (ASCEND-4): a randomised, open-label, phase 3 study. Lancet, 2017, 389(10072): 917-929.
20. Planchard D, Smit EF, Groen HJM, et al. Dabrafenib plus trametinib in patients with previously untreated BRAF^V600E-mutant metastatic non-small-cell lung cancer: an open-label, phase 2 trial. Lancet Oncol, 2017, 18(10): 1307-1316.
21. Rittmeyer A, Barlesi F, Waterkamp D, et al. Atezolizumab versus docetaxel in patients with previously treated non-small-cell lung cancer (OAK): a phase 3, open-label, multicentre randomised controlled trial. Lancet, 2017, 389(166): 255-265.
22. Ciuleanu T, Brodowicz T, Zielinski C, et al. Maintenance pemetrexed plus best supportive care versus placebo plus best supportive care for non-small-cell lung cancer: a randomised, double-blind, phase 3 study. Lancet, 2009, 374(9699): 1432-1440.
23. Chun SG, Hu C, Choy H, et al. Impact of intensity-modulated radiation therapy technique for locally advanced non-small-cell lung cancer: a secondary analysis of the NRG oncology RTOG 0617 randomized clinical trial. J Clin Oncol, 2017, 35(1): 56-62.

West China Medical Journal

Interpretation of updated NCCN guidelines for non-small cell lung cancer (version 3. 2018)

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