NCCN指南-非小细胞肺癌-2020版.pdf

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1、NCCN.orgNCCN Guidelines for PatientsVersion 6.2020, 06/15/20 2020 National Comprehensive Cancer Network (NCCN), All rights reserved. NCCN Guidelines and this illustration may not be reproduced in any form without the express written permission of NCCN.NCCN Clinical Practice Guidelines in Oncology (N

2、CCN Guidelines)Non-Small Cell Lung CancerVersion 6.2020 June 15, 2020ContinueContinueNCCN Guidelines Panel Disclosures Interventional radiology Hematology/Hematology oncology Internal medicine Medical oncology Pathology Patient advocate Radiation oncology/Radiotherapy Surgery/Surgical oncology*Discu

3、ssion Section Writing Committee*David S. Ettinger, MD/Chair The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins*Douglas E. Wood, MD/Vice Chair Fred Hutchinson Cancer Research Center/Seattle Cancer Care AllianceDara L. Aisner, MD, PhD University of Colorado Cancer CenterWallace Akerley, MD

4、 Huntsman Cancer Institute at the University of UtahJessica R. Bauman, MD Fox Chase Cancer CenterAnkit Bharat, MD Robert H. Lurie Comprehensive Cancer Center of Northwestern UniversityDebora S. Bruno, MD, MS Case Comprehensive Cancer Center/ University Hospitals Seidman Cancer Center and Cleveland C

5、linic Taussig Cancer InstituteJoe Y. Chang, MD, PhD The University of Texas MD Anderson Cancer CenterLucian R. Chirieac, MD Dana-Farber/Brigham and Womens Cancer CenterThomas A. DAmico, MD Duke Cancer InstituteThomas J. Dilling, MD, MS Moffitt Cancer CenterMichael Dobelbower, MD, PhD ONeal Comprehen

6、sive Cancer Center at UABScott Gettinger, MD Yale Cancer Center/Smilow Cancer HospitalRamaswamy Govindan, MD Siteman Cancer Center at Barnes- Jewish Hospital and Washington University School of MedicineMatthew A. Gubens, MD, MS UCSF Helen Diller Family Comprehensive Cancer CenterMark Hennon, MD Rosw

7、ell Park Comprehensive Cancer CenterLeora Horn, MD, MSc Vanderbilt-Ingram Cancer CenterRudy P. Lackner, MD Fred & Pamela Buffett Cancer CenterMichael Lanuti, MD Massachusetts General Hospital Cancer CenterTiciana A. Leal, MD University of Wisconsin Carbone Cancer CenterJules Lin, MD University of Mi

8、chigan Rogel Cancer CenterBilly W. Loo, Jr., MD, PhD Stanford Cancer Institute Renato G. Martins, MD, MPH Fred Hutchinson Cancer Research Center/ Seattle Cancer Care AllianceErminia Massarelli, MD City of Hope National Medical Center Gregory A. Otterson, MD The Ohio State University Comprehensive Ca

9、ncer Center - James Cancer Hospital and Solove Research InstituteSandip P. Patel, MD UC San Diego Moores Cancer CenterGregory J. Riely, MD, PhD Memorial Sloan Kettering Cancer CenterSteven E. Schild, MD Mayo Clinic Cancer CenterTheresa A. Shapiro, MD, PhD The Sidney Kimmel Comprehensive Cancer Cente

10、r at Johns HopkinsAditi P. Singh, MD Abramson Cancer Center at the University of PennsylvaniaJames Stevenson, MD Case Comprehensive Cancer Center/ University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer InstituteAlda Tam The University of Texas MD Anderson Cancer CenterKurt W.

11、 Tauer, MD St. Jude Childrens Research Hospital/ University of Tennessee Health Science CenterStephen C. Yang, MD The Sidney Kimmel Comprehensive Cancer Center at Johns HopkinsNCCNKristina Gregory, RN, MSN, OCNMiranda Hughes, PhDNCCN Guidelines Version 6.2020Non-Small Cell Lung CancerVersion 6.2020,

12、 06/15/20 2020 National Comprehensive Cancer Network (NCCN), All rights reserved. NCCN Guidelines and this illustration may not be reproduced in any form without the express written permission of NCCN.NCCN Guidelines IndexTable of ContentsDiscussionPrinted by Li Jianxin on 6/19/2020 12:16:27 AM. For

13、 personal use only. Not approved for distribution. Copyright 2020 National Comprehensive Cancer Network, Inc., All Rights Reserved.Clinical Trials: NCCN believes that the best management for any patient with cancer is in a clinical trial. Participation in clinical trials is especially encouraged. To

14、 find clinical trials online at NCCN Member Institutions, click here:nccn.org/clinical_trials/member_institutions.aspx.NCCN Categories of Evidence and Consensus: All recommendations are category 2A unless otherwise indicated. See NCCN Categories of Evidence and Consensus.NCCN Categories of Preferenc

15、e: All recommendations are considered appropriate.See NCCN Categories of Preference.NCCN Non-Small Cell Lung Cancer Panel MembersSummary of Guidelines UpdatesLung Cancer Prevention and Screening (PREV-1)Clinical Presentation and Risk Assessment (DIAG-1)Initial Evaluation and Clinical Stage (NSCL-1)E

16、valuation and Treatment: Stage IA (T1abc, N0) (NSCL-2) Stage IB (peripheral T2a, N0), Stage I (central T1abc-T2a, N0), Stage II (T1abc-2ab, N1; T2b, N0), Stage IIB (T3, N0), and Stage IIIA (T3, N1) (NSCL-3) Stage IIB (T3 invasion, N0) and Stage IIIA (T4 extension, N0-1; T3, N1; T4, N0-1) (NSCL-5) St

17、age IIIA (T1-2, N2); Stage IIIB (T3, N2); Separate Pulmonary Nodule(s) (Stage IIB, IIIA, IV) (NSCL-8) Multiple Lung Cancers (N0-1) (NSCL-11) Stage IIIB (T1-2, N3); Stage IIIC (T3, N3) (NSCL-12) Stage IIIB (T4, N2); Stage IIIC (T4, N3); Stage IVA, M1a: Pleural or Pericardial Effusion (NSCL-13) Stage

18、IVA, M1b (NSCL-14)Surveillance After Completion of Definitive Therapy (NSCL-16)Therapy for Recurrence and Metastasis (NSCL-17)Systemic Therapy for Advanced or Metastatic Disease (NSCL-18)Principles of Pathologic Review (NSCL-A)Principles of Surgical Therapy (NSCL-B)Principles of Radiation Therapy (N

19、SCL-C)Chemotherapy Regimens for Neoadjuvant and Adjuvant Therapy (NSCL-D)Chemotherapy Regimens Used with Radiation Therapy (NSCL-E)Cancer Survivorship Care (NSCL-F)Principles of Molecular and Biomarker Analysis (NSCL-G)Emerging Biomarkers to Identify Novel Therapies for Patients with Metastatic NSCL

20、C (NSCL-H)Targeted Therapy or Immunotherapy for Advanced or Metastatic Disease (NSCL-I)Systemic Therapy for Advanced or Metastatic Disease (NSCL-J)Staging (ST-1)The NCCN Guidelines are a statement of evidence and consensus of the authors regarding their views of currently accepted approaches to trea

21、tment. Any clinician seeking to apply or consult the NCCN Guidelines is expected to use independent medical judgment in the context of individual clinical circumstances to determine any patients care or treatment. The National Comprehensive Cancer Network (NCCN) makes no representations or warrantie

22、s of any kind regarding their content, use or application and disclaims any responsibility for their application or use in any way. The NCCN Guidelines are copyrighted by National Comprehensive Cancer Network. All rights reserved. The NCCN Guidelines and the illustrations herein may not be reproduce

23、d in any form without the express written permission of NCCN. 2020.NCCN Guidelines Version 6.2020Non-Small Cell Lung CancerVersion 6.2020, 06/15/20 2020 National Comprehensive Cancer Network (NCCN), All rights reserved. NCCN Guidelines and this illustration may not be reproduced in any form without

24、the express written permission of NCCN.NCCN Guidelines IndexTable of ContentsDiscussionPrinted by Li Jianxin on 6/19/2020 12:16:27 AM. For personal use only. Not approved for distribution. Copyright 2020 National Comprehensive Cancer Network, Inc., All Rights Reserved.Updates in Version 5.2020 of th

25、e NCCN Guidelines for Non-Small Cell Lung Cancer from Version 4.2020 include:NSCL-30 Atezolizumab added as a preferred first-line treatment option for patients with metastatic NSCLC, PD-L1 50%, and PS 0-2. NSCL-I 1 of 2 and NSCL-I 2 of 2 Atezolizumab added with reference.MS-1 Discussion section upda

26、ted to reflect the changes in the algorithm.Updates in Version 6.2020 of the NCCN Guidelines for Non-Small Cell Lung Cancer from Version 5.2020 include:NSCL-30 and NSCL-31 Adenocarcinoma, large cell, NSCLC NOS: Nivolumab + ipilimumab + pemetrexed + (carboplatin or cisplatin) added as an other recomm

27、ended first-line treatment option for patients with metastatic NSCLC, PD-L1 1%, and PS 0-2. Squamous cell carcinoma: Nivolumab + ipilimumab + paclitaxel + carboplatin added as an other recommended first-line treatment option for patients with metastatic NSCLC, PD-L1 1%, and PS 0-2.NSCL-I 1 of 2 and

28、NSCL-I 2 of 2 The following regimens added with references: Nivolumab + ipilimumab + pemetrexed + (carboplatin or cisplatin)Nivolumab + ipilimumab + paclitaxel + carboplatinNSCL-J 2 of 4 Adenocarcinoma, large cell, NSCLC NOS: Nivolumab + ipilimumab + pemetrexed + (carboplatin or cisplatin) added as

29、an other recommended first-line treatment option for patients with metastatic NSCLC, PD-L1 1%, and PS 0-1.NSCL-J 3 of 4 Squamous cell carcinoma: Nivolumab + ipilimumab + paclitaxel + carboplatin added as an other recommended first-line treatment option for patients with metastatic NSCLC, PD-L1 1%, a

30、nd PS 0-1.NSCL-J 4 of 4 Reference 6 added.MS-1 Discussion section updated to reflect the changes in the algorithm.ContinuedNCCN Guidelines Version 6.2020Non-Small Cell Lung CancerVersion 6.2020, 06/15/20 2020 National Comprehensive Cancer Network (NCCN), All rights reserved. NCCN Guidelines and this

31、 illustration may not be reproduced in any form without the express written permission of NCCN.NCCN Guidelines IndexTable of ContentsDiscussionPrinted by Li Jianxin on 6/19/2020 12:16:27 AM. For personal use only. Not approved for distribution. Copyright 2020 National Comprehensive Cancer Network, I

32、nc., All Rights Reserved.Updates in Version 2.2020 of the NCCN Guidelines for Non-Small Cell Lung Cancer from Version 1.2020 include:NSCL-19 The following regimens added for the first-line treatment of patients with metastatic NSCLC and an EGFR mutation. Erlotinib + ramucirumab as an other recommend

33、ed treatment option as a category 2A.Erlotinib + bevacizumab as a useful in certain circumstances treatment option as a category 2B.NSCL-28 The following treatment options added for patients with metastatic NSCLC, PD-L1 1%, and PS 0-2. (also applies to NSCL-29)Carboplatin + albumin-bound paclitaxel

34、+ atezolizumab as an other recommended treatment option as a category 2A. Nivolumab + ipilimumab as a useful in certain circumstances treatment option as a category 2A. Continuation MaintenanceAtezolizumab added as a treatment option, if atezolizumab/carboplatin/albumin-bound paclitaxel given.NSCL-2

35、9 and NSCL-30 Continuation MaintenanceAtezolizumab added as a treatment option, if atezolizumab/carboplatin/albumin-bound paclitaxel given.Updates in Version 3.2020 of the NCCN Guidelines for Non-Small Cell Lung Cancer from Version 2.2020 include:MS-1 Discussion section updated based on the changes

36、in the algorithm.ContinuedUpdates in Version 4.2020 of the NCCN Guidelines for Non-Small Cell Lung Cancer from Version 3.2020 include:NSCL-18 MET exon 14 skipping mutation added. RET rearrangement added. NSCL-28 New page added to address treatment recommendations for MET exon 14 skipping mutations.N

37、SCL-29 New page added to address treatment recommendations for RET rearrangements.NSCL-H MET exon 14 skipping mutation and associated references removed from the table. RET rearrangement and associated references removed from the table.NSCL-I 1 of 2 and NSCL-I 2 of 2 Capmatinib and crizotinib added

38、with references. Selpercatinib, cabozantinib, and vandetanib added with references.MS-1 Discussion section updated to reflect the changes in the algorithm.NCCN Guidelines Version 6.2020Non-Small Cell Lung CancerVersion 6.2020, 06/15/20 2020 National Comprehensive Cancer Network (NCCN), All rights re

39、served. NCCN Guidelines and this illustration may not be reproduced in any form without the express written permission of NCCN.NCCN Guidelines IndexTable of ContentsDiscussionPrinted by Li Jianxin on 6/19/2020 12:16:27 AM. For personal use only. Not approved for distribution. Copyright 2020 National

40、 Comprehensive Cancer Network, Inc., All Rights Reserved.UPDATESUpdates in Version 1.2020 of the NCCN Guidelines for Non-Small Cell Lung Cancer from Version 7.2019 include:GENERAL: Preference Stratification applied throughout Guidelines.DIAG-2 Footnote j: Previous version: Patients with a suspicion

41、of lung cancer after PET/CT require histologic confirmation before any nonsurgical therapy. When a biopsy is not possible, a multidisciplinary evaluation should be done including radiation oncology, surgery, and interventional pulmonology. Updated version: Patients require tissue confirmation of lun

42、g cancer before any nonsurgical therapy. Multidisciplinary evaluation that at least includes interventional radiology, thoracic surgery, and interventional pulmonology is recommended to determine the safest and most efficient approach, or to provide consensus that a biopsy is too risky or difficult

43、and that the patient can proceed with therapy without tissue confirmation. (IJsseldijk MA, Shoni M, Siegert C, et al. Survival after stereotactic body radiation therapy for clinically diagnosed or biopsy-proven early-stage NSCLC: A systematic review and meta-analysis. J Thorac Oncol 2019;14:583-595.

44、) (also applies to DIAG-3; same footnote added as footnote n on NSCL-2, NSCL-3)NSCL-1 Last bullet added: For tools to aid in the optimal assessment and management of older adults, see the NCCN Guidelines for Older Adult OncologyNSCL-2 Footnote m modified: Interventional radiology ablation Image-guid

45、ed thermal ablation is an option for selected patients. (also applies to NSCL-17; footnote added to NSCL-15, NSCL-20, NSCL-21, NSCL-23, and NSCL-24)NSCL-3 Medically inoperable; N0: Consider adjuvant chemotherapy changed from a category 2B recommendation to a category 2A recommendation. Footnote t ad

46、ded: Durvalumab is not recommended for patients following definitive surgical resection. (also applies to NSCL-6, NSCL-7, NSCL-9, NSCL-12, and NSCL-13)NSCL-7 Chest wall, proximal airway, or mediastinum (T3 invasion, N0-1; resectable T4 extension, N0-1) and Stage IIIA (T4, N0-1): Surgical reevaluatio

47、n including chest CT PET/CT added after concurrent chemoradiation or chemotherapy.ContinuedUpdates in Version 2.2020 of the NCCN Guidelines for Non-Small Cell Lung Cancer from Version 1.2020 include:NSCL-I 1 of 2 and NSCL-I 2 of 2 Regimens and references added for combination therapies for metastati

48、c NSCLC: erlotinib + ramucirumab, erlotinib + bevacizumab, carboplatin + albumin-bound paclitaxel + atezolizumab, and nivolumab + ipilimumab.NSCL-J 2 of 4 The following treatment options added for patients with metastatic nonsquamous NSCLC, PD-L1 1%, and PS 0-1.Carboplatin + albumin-bound paclitaxel

49、 + atezolizumab as an other recommended treatment option as a category 2A. Nivolumab + ipilimumab as an other recommended treatment option as a category 2A. NSCL-J 3 of 4 The following treatment options added for patients with metastatic squamous cell NSCLC, PD-L1 1%, and PS 0-1.Nivolumab + ipilimum

50、ab as an other recommended treatment option as a category 2A. NCCN Guidelines Version 6.2020Non-Small Cell Lung CancerVersion 6.2020, 06/15/20 2020 National Comprehensive Cancer Network (NCCN), All rights reserved. NCCN Guidelines and this illustration may not be reproduced in any form without the e