Interpretation of the NCCN clinical practice guidelines in oncology for non-small cell lung cancer (version 2.2023)_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WANG Wenjie ¹ , XU Chenzhen ¹ , GAO Minglang ¹ , YAO Yi ² ,  GENG Qing ¹

1. Department of Thoracic Surgery, Renmin Hospital of Wuhan University, Wuhan, 430060, P. R. China;
2. Cancer Center, Renmin Hospital of Wuhan University, Wuhan, 430060, P. R. China;

Corresponding author：

GENG Qing, Email: gengqingwhu@whu.edu.cn

Keywords：

Non-small cell lung cancer; NCCN guideline; guideline interpretation

DOI：

10.7507/1007-4848.202303041

Video：

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Lung cancer is the malignancy with the highest incidence and mortality rate in China. In recent years, the popular use of low-dose computed tomography in the population has led to an increase in the detection rate of pulmonary nodules. The National Comprehensive Cancer Network (NCCN) updated and released the NCCN clinical practice guidelines in oncology for non-small cell lung cancer (version 2.2023) on February 17, 2023. This article will interpret the main updates of the new guideline and compare it with the domestic lung cancer treatment guidelines, providing new ideas for the diagnosis and treatment of lung cancer for Chinese clinicians.

Citation： WANG Wenjie, XU Chenzhen, GAO Minglang, YAO Yi, GENG Qing. Interpretation of the NCCN clinical practice guidelines in oncology for non-small cell lung cancer (version 2.2023). Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2023, 30(5): 660-664. doi: 10.7507/1007-4848.202303041 Copy

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2.	李学祥, 王慜杰, 高佳, 等. 肺肿瘤患者临床病理特征回顾性分析. 中华肿瘤防治杂志, 2012, 19(2): 130-133.
3.	Ganti AK, Klein AB, Cotarla I, et al. Update of incidence, prevalence, survival, and initial treatment in patients with non–small cell lung cancer in the US. JAMA Oncol, 2021, 7(12): 1824.
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6.	中华医学会肿瘤学分会, 中华医学会杂志社. 中华医学会肺癌临床诊疗指南(2022版). 中华医学杂志, 2022, 102(23): 1706-1740.
7.	Rintoul RC, Tournoy KG, Daly HE, et al. EBUS-TBNA for the clarification of PET positive intra-thoracic lymph nodes-an international multi-centre experience. J Thorac Oncol, 2009, 4(1): 44-48.
8.	Meyers BF, Haddad F, Siegel BA, et al. Cost-effectiveness of routine mediastinoscopy in computed tomography- and positron emission tomography-screened patients with stageⅠ lung cancer. J Thorac Cardiovasc Surg, 2006, 131(4): 822-829.
9.	Girard N, Deshpande C, Azzoli CG, et al. Use of epidermal growth factor receptor/kirsten rat sarcoma 2 viral oncogene homolog mutation testing to define clonal relationships among multiple lung adenocarcinomas. Chest, 2010, 137(1): 46-52.
10.	Asamura H. Multiple primary cancers or multiple metastases, That is the question. J Thorac Oncol, 2010, 5(7): 930-931.
11.	Forde PM, Spicer J, Lu S, et al. Neoadjuvant nivolumab plus chemotherapy in resectable lung cancer. N Engl J Med, 2022, 386(21): 1973-1985.
12.	Imfinzi plus chemotherapy significantly improved pathologic complete response in AEGEAN phase Ⅲ trial in resectable non-small cell lung cancer. URL: https://www.astrazeneca.com/media-centre/press-releases/2022/imfinzi-improved-pcr-in-resectable-lung-cancer.html.
13.	Felip E, Altorki N, Zhou C, et al. Adjuvant atezolizumab after adjuvant chemotherapy in resected stage ⅠB–ⅢA non-small-cell lung cancer (IMpower010): A randomised, multicentre, open-label, phase 3 trial. Lancet, 2021, 398(10308): 1344-1357.
14.	O'Brien M, Paz-Ares L, Marreaud S, et al. Pembrolizumab versus placebo as adjuvant therapy for completely resected stageⅠB–ⅢA non-small-cell lung cancer (PEARLS/KEYNOTE-091): An interim analysis of a randomised, triple-blind, phase 3 trial. Lancet Oncol, 2022, 23(10): 1274-1286.
15.	Paz-Ares L, Ciuleanu T, Cobo M, et al. First-line nivolumab plus ipilimumab combined with two cycles of chemotherapy in patients with non-small-cell lung cancer (CheckMate 9LA): An international, randomised, open-label, phase 3 trial. Lancet Oncol, 2021, 22(2): 198-211.
16.	Johnson ML, Cho BC, Luft A, et al. Durvalumab with or without tremelimumab in combination with chemotherapy as first-line therapy for metastatic non–small-cell lung cancer: The phase Ⅲ POSEIDON Study. J Clin Oncol, 2023, 41(6): 1213-1227.
17.	Hellmann MD, Paz-Ares L, Bernabe Caro R, et al. Nivolumab plus ipilimumab in advanced non-small-cell lung cancer. N Engl J Med, 2019, 381(21): 2020-2031.
18.	Marcoux N, Gettinger SN, O Kane G, et al. EGFR-mutant adenocarcinomas that transform to small-cell lung cancer and other neuroendocrine carcinomas: Clinical outcomes. J Clin Oncol, 2019, 37(4): 278-285.
19.	Jänne PA, Riely GJ, Gadgeel SM, et al. Adagrasib in non-small-cell lung cancer harboring a KRASG12C mutation. N Engl J Med, 2022, 387(2): 120-131.
20.	Le Pechoux C, Pourel N, Barlesi F, et al. Postoperative radiotherapy versus no postoperative radiotherapy in patients with completely resected non-small-cell lung cancer and proven mediastinal N2 involvement (Lung ART, IFCT 0503): An open-label, randomised, phase 3 trial. Lancet Oncol, 2022, 23(1): 104-114.
21.	Hui Z, Men Y, Hu C, et al. Effect of postoperative radiotherapy for patients with pⅢA-N2 non-small cell lung cancer after complete resection and adjuvant chemotherapy. JAMA Oncol, 2021, 7(8): 1178.
22.	Bradley JD, Paulus R, Graham MV, et al. PhaseⅡtrial of postoperative adjuvant paclitaxel/carboplatin and thoracic radiotherapy in resected stageⅡ and ⅢA non-small-cell lung cancer: Promising long-term results of the radiation therapy oncology group—RTOG 9705. J Clin Oncol, 2005, 23(15): 3480-3487.
23.	Keller SM, Adak S, Wagner H, et al. A randomized trial of postoperative adjuvant therapy in patients with completely resected stage Ⅱor Ⅲa non-small-cell lung cancer. N Engl J Med, 2000, 343(17): 1217-1222.
24.	Hancock JG, Rosen JE, Antonicelli A, et al. Impact of adjuvant treatment for microscopic residual disease after non-small cell lung cancer surgery. Ann Thorac Surg, 2015, 99(2): 406-413.
25.	Burdett S, Stewart L. Postoperative radiotherapy in non-small-cell lung cancer: Update of an individual patient data meta-analysis. Lung Cancer, 2005, 47(1): 81-83.
26.	Spoelstra FOB, Senan S, Le Péchoux C, et al. Variations in target volume definition for postoperative radiotherapy in stage Ⅲ non-small-cell lung cancer: Analysis of an International Contouring Study. Int J Radiat Oncol Biol Phys, 2010, 76(4): 1106-1113.

1. Zheng R, Zhang S, Zeng H, et al. Cancer incidence and mortality in China, 2016. JNCC, 2022, 2(1): 1-9.
2. 李学祥, 王慜杰, 高佳, 等. 肺肿瘤患者临床病理特征回顾性分析. 中华肿瘤防治杂志, 2012, 19(2): 130-133.
3. Ganti AK, Klein AB, Cotarla I, et al. Update of incidence, prevalence, survival, and initial treatment in patients with non–small cell lung cancer in the US. JAMA Oncol, 2021, 7(12): 1824.
4. NCCN. The NCCN clinical practice guidelines in oncology for non-small cell lung cancer (version 2.2023). URL: https://www.nccn.org/.
5. NCCN. The NCCN clinical practice guidelines in oncology for non-small cell lung cancer (version 6.2022). URL: https://www.nccn.org/.
6. 中华医学会肿瘤学分会, 中华医学会杂志社. 中华医学会肺癌临床诊疗指南(2022版). 中华医学杂志, 2022, 102(23): 1706-1740.
7. Rintoul RC, Tournoy KG, Daly HE, et al. EBUS-TBNA for the clarification of PET positive intra-thoracic lymph nodes-an international multi-centre experience. J Thorac Oncol, 2009, 4(1): 44-48.
8. Meyers BF, Haddad F, Siegel BA, et al. Cost-effectiveness of routine mediastinoscopy in computed tomography- and positron emission tomography-screened patients with stageⅠ lung cancer. J Thorac Cardiovasc Surg, 2006, 131(4): 822-829.
9. Girard N, Deshpande C, Azzoli CG, et al. Use of epidermal growth factor receptor/kirsten rat sarcoma 2 viral oncogene homolog mutation testing to define clonal relationships among multiple lung adenocarcinomas. Chest, 2010, 137(1): 46-52.
10. Asamura H. Multiple primary cancers or multiple metastases, That is the question. J Thorac Oncol, 2010, 5(7): 930-931.
11. Forde PM, Spicer J, Lu S, et al. Neoadjuvant nivolumab plus chemotherapy in resectable lung cancer. N Engl J Med, 2022, 386(21): 1973-1985.
12. Imfinzi plus chemotherapy significantly improved pathologic complete response in AEGEAN phase Ⅲ trial in resectable non-small cell lung cancer. URL: https://www.astrazeneca.com/media-centre/press-releases/2022/imfinzi-improved-pcr-in-resectable-lung-cancer.html.
13. Felip E, Altorki N, Zhou C, et al. Adjuvant atezolizumab after adjuvant chemotherapy in resected stage ⅠB–ⅢA non-small-cell lung cancer (IMpower010): A randomised, multicentre, open-label, phase 3 trial. Lancet, 2021, 398(10308): 1344-1357.
14. O'Brien M, Paz-Ares L, Marreaud S, et al. Pembrolizumab versus placebo as adjuvant therapy for completely resected stageⅠB–ⅢA non-small-cell lung cancer (PEARLS/KEYNOTE-091): An interim analysis of a randomised, triple-blind, phase 3 trial. Lancet Oncol, 2022, 23(10): 1274-1286.
15. Paz-Ares L, Ciuleanu T, Cobo M, et al. First-line nivolumab plus ipilimumab combined with two cycles of chemotherapy in patients with non-small-cell lung cancer (CheckMate 9LA): An international, randomised, open-label, phase 3 trial. Lancet Oncol, 2021, 22(2): 198-211.
16. Johnson ML, Cho BC, Luft A, et al. Durvalumab with or without tremelimumab in combination with chemotherapy as first-line therapy for metastatic non–small-cell lung cancer: The phase Ⅲ POSEIDON Study. J Clin Oncol, 2023, 41(6): 1213-1227.
17. Hellmann MD, Paz-Ares L, Bernabe Caro R, et al. Nivolumab plus ipilimumab in advanced non-small-cell lung cancer. N Engl J Med, 2019, 381(21): 2020-2031.
18. Marcoux N, Gettinger SN, O Kane G, et al. EGFR-mutant adenocarcinomas that transform to small-cell lung cancer and other neuroendocrine carcinomas: Clinical outcomes. J Clin Oncol, 2019, 37(4): 278-285.
19. Jänne PA, Riely GJ, Gadgeel SM, et al. Adagrasib in non-small-cell lung cancer harboring a KRASG12C mutation. N Engl J Med, 2022, 387(2): 120-131.
20. Le Pechoux C, Pourel N, Barlesi F, et al. Postoperative radiotherapy versus no postoperative radiotherapy in patients with completely resected non-small-cell lung cancer and proven mediastinal N2 involvement (Lung ART, IFCT 0503): An open-label, randomised, phase 3 trial. Lancet Oncol, 2022, 23(1): 104-114.
21. Hui Z, Men Y, Hu C, et al. Effect of postoperative radiotherapy for patients with pⅢA-N2 non-small cell lung cancer after complete resection and adjuvant chemotherapy. JAMA Oncol, 2021, 7(8): 1178.
22. Bradley JD, Paulus R, Graham MV, et al. PhaseⅡtrial of postoperative adjuvant paclitaxel/carboplatin and thoracic radiotherapy in resected stageⅡ and ⅢA non-small-cell lung cancer: Promising long-term results of the radiation therapy oncology group—RTOG 9705. J Clin Oncol, 2005, 23(15): 3480-3487.
23. Keller SM, Adak S, Wagner H, et al. A randomized trial of postoperative adjuvant therapy in patients with completely resected stage Ⅱor Ⅲa non-small-cell lung cancer. N Engl J Med, 2000, 343(17): 1217-1222.
24. Hancock JG, Rosen JE, Antonicelli A, et al. Impact of adjuvant treatment for microscopic residual disease after non-small cell lung cancer surgery. Ann Thorac Surg, 2015, 99(2): 406-413.
25. Burdett S, Stewart L. Postoperative radiotherapy in non-small-cell lung cancer: Update of an individual patient data meta-analysis. Lung Cancer, 2005, 47(1): 81-83.
26. Spoelstra FOB, Senan S, Le Péchoux C, et al. Variations in target volume definition for postoperative radiotherapy in stage Ⅲ non-small-cell lung cancer: Analysis of an International Contouring Study. Int J Radiat Oncol Biol Phys, 2010, 76(4): 1106-1113.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Interpretation of the NCCN clinical practice guidelines in oncology for non-small cell lung cancer (version 2.2023)

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