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Non-Small Cell Lung Cancer NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) Non-Small Cell Lung Cancer Version 3.2020 — February 11, 2020 NCCN.org NCCN Guidelines for Patients® Continue Version 3.2020, 02/11/20 © 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 Index NCCN Guidelines Version 3.2020 Table of Contents Non-Small Cell Lung Cancer Discussion *David S. Ettinger, MD/Chair † Michael Dobelbower, MD, PhD § Gregory A. Otterson, MD † The Sidney Kimmel Comprehensive O'Neal Comprehensive Cancer Center at UAB The Ohio State University Comprehensive Cancer Center at Johns Hopkins Cancer Center - James Cancer Hospital Scott Gettinger, MD † Þ and Solove Research Institute *Douglas E. Wood, MD/Vice Chair ¶ Yale Cancer Center/Smilow Cancer Hospital Fred Hutchinson Cancer Research Center/ Ramaswamy Govindan, MD † Sandip P. Patel, MD ‡ † Þ Seattle Cancer Care Alliance Siteman Cancer Center at Barnes- UC San Diego Moores Cancer Center Dara L. Aisner, MD, PhD ≠ Jewish Hospital and Washington Gregory J. Riely, MD, PhD † Þ University of Colorado Cancer Center University School of Medicine Memorial Sloan Kettering Cancer Center Wallace Akerley, MD † Matthew A. Gubens, MD, MS † Steven E. Schild, MD § Huntsman Cancer Institute UCSF Helen Diller Family Mayo Clinic Cancer Center at the University of Utah Comprehensive Cancer Center Theresa A. Shapiro, MD, PhD ¥ Þ Jessica R. Bauman, MD ‡ † Mark Hennon, MD ¶ The Sidney Kimmel Comprehensive Fox Chase Cancer Center Roswell Park Comprehensive Cancer Center Cancer Center at Johns Hopkins Ankit Bharat, MD ¶ Leora Horn, MD, MSc † Aditi P. Singh, MD † Robert H. Lurie Comprehensive Cancer Vanderbilt-Ingram Cancer Center Abramson Cancer Center at the Center of Northwestern University University of Pennsylvania Rudy P. Lackner, MD ¶ Debora S. Bruno, MD, MS † Fred & Pamela Buffett Cancer Center James Stevenson, MD † Case Comprehensive Cancer Center/ Case Comprehensive Cancer Center/ Michael Lanuti, MD ¶ University Hospitals Seidman Cancer Massachusetts General Hospital Cancer Center University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Center and Cleveland Clinic Taussig Cancer Institute Ticiana A. Leal, MD † Cancer Institute University of Wisconsin Carbone Cancer Center Joe Y. Chang, MD, PhD § Alda Tam ф The University of Texas Jules Lin, MD ¶ The University of Texas MD Anderson Cancer Center University of Michigan Rogel Cancer Center MD Anderson Cancer Center Lucian R. Chirieac, MD ≠ Billy W. Loo, Jr., MD, PhD § Kurt W. Tauer, MD † Dana-Farber/Brigham and Women’s Stanford Cancer Institute St. Jude Children’s Research Hospital/ Cancer Center Renato G. Martins, MD, MPH † University of Tennessee Health Science Center Thomas A. D’Amico, MD ¶ Fred Hutchinson Cancer Research Center/ Stephen C. Yang, MD ¶ Duke Cancer Institute Seattle Cancer Care Alliance The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Thomas J. Dilling, MD, MS § Erminia Massarelli, MD † Moffitt Cancer Center City of Hope National Medical Center NCCN Continue ф Interventional radiology ¥ Patient advocate Kristina Gregory, RN, MSN, OCN ‡ Hematology/Hematology § Radiation oncology/Radiotherapy Miranda Hughes, PhD oncology ¶ Surgery/Surgical oncology Þ Internal medicine *Discussion Section Writing † Medical oncology Committee NCCN Guidelines Panel Disclosures ≠ Pathology Version 3.2020, 02/11/20 © 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 Index NCCN Guidelines Version 3.2020 Table of Contents Non-Small Cell Lung Cancer Discussion NCCN Non-Small Cell Lung Cancer Panel Members Summary of Guidelines Updates Clinical Trials: NCCN believes that the best management for any patient Lung Cancer Prevention and Screening (PREV-1) with cancer is in a clinical trial. Clinical Presentation and Risk Assessment (DIAG-1) Participation in clinical trials is Initial Evaluation and Clinical Stage (NSCL-1) especially encouraged. Evaluation and Treatment: To find clinical trials online at NCCN • Stage IA (T1abc, N0) (NSCL-2) • Stage IB (peripheral T2a, N0), Stage I (central T1abc-T2a, N0), Member Institutions, click here: Stage II (T1abc-2ab, N1; T2b, N0), Stage IIB (T3, N0), and Stage IIIA (T3, N1) (NSCL-3) nccn.org/clinical_trials/member_ • Stage IIB (T3 invasion, N0) and Stage IIIA (T4 extension, N0-1; T3, N1; T4, N0-1) (NSCL-5) institutions.aspx. • Stage IIIA (T1-2, N2); Stage IIIB (T3, N2); Separate Pulmonary Nodule(s) (Stage IIB, IIIA, IV) (NSCL-8) NCCN Categories of Evidence and • Multiple Lung Cancers (N0-1) (NSCL-11) Consensus: All recommendations • Stage IIIB (T1-2, N3); Stage IIIC (T3, N3) (NSCL-12) are category 2A unless otherwise • Stage IIIB (T4, N2); Stage IIIC (T4, N3); Stage IVA, M1a: Pleural or Pericardial Effusion (NSCL-13) indicated. • Stage IVA, M1b (NSCL-14) Surveillance After Completion of Definitive Therapy (NSCL-16) See NCCN Categories of Evidence Therapy for Recurrence and Metastasis (NSCL-17) and Consensus. Systemic Therapy for Advanced or Metastatic Disease (NSCL-18) NCCN Categories of Preference: Principles of Pathologic Review (NSCL-A) All recommendations are considered Principles of Surgical Therapy (NSCL-B) appropriate. Principles of Radiation Therapy (NSCL-C) See NCCN Categories of Preference. 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 NSCLC (NSCL-H) Targeted Therapy 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 treatment. 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 patient’s care or treatment. The National Comprehensive Cancer Network® (NCCN®) makes no representations or warranties 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 reproduced in any form without the express written permission of NCCN. ©2020. Version 3.2020, 02/11/20 © 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 Index NCCN Guidelines Version 3.2020 Table of Contents Non-Small Cell Lung Cancer Discussion 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 in the algorithm. 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 recommended" 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 + 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 Maintenance Atezolizumab added as a treatment option, if atezolizumab/carboplatin/albumin-bound paclitaxel given. NSCL-29 and NSCL-30 • Continuation Maintenance Atezolizumab added as a treatment option, if atezolizumab/carboplatin/albumin-bound paclitaxel given. NSCL-I 1 of 2 and NSCL-I 2 of 2 • Regimens and references added for combination therapies for metastatic 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 + 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 + ipilimumab as an "other recommended" treatment option as a category 2A. Version 3.2020, 02/11/20 © 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 Index NCCN Guidelines Version 3.2020 Table of Contents Non-Small Cell Lung Cancer Discussion Updates in Version 1.2020 of the NCCN Guidelines for Non-Small Cell Lung Cancer from Version 7.2019 include: GENERAL: Preference Stratification
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