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(NCCN Guidelines®) Non-Small Cell Lung Cancer Version 3.2018 — February 21, 2018 NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) Non-Small Cell Lung Cancer Version 3.2018 — February 21, 2018 NCCN.org NCCN Guidelines for Patients® available at www.nccn.org/patients Continue Version 3.2018, 02/21/18 © National Comprehensive Cancer Network, Inc. 2018, All rights reserved. The NCCN Guidelines® and this illustration may not be reproduced in any form without the express written permission of NCCN®. Printed by Anton Kabakov on 3/5/2018 6:58:05 AM. For personal use only. Not approved for distribution. Copyright © 2018 National Comprehensive Cancer Network, Inc., All Rights Reserved. NCCN Guidelines Version 3.2018 Panel Members NCCN Guidelines Index Table of Contents Non-Small Cell Lung Cancer Discussion *David S. Ettinger, MD/Chair † Ramaswamy Govindan, MD † Gregory A. Otterson, MD † The Sidney Kimmel Comprehensive Siteman Cancer Center at Barnes- The Ohio State University Comprehensive Cancer Center at Johns Hopkins Jewish Hospital and Washington Cancer Center - James Cancer Hospital University School of Medicine and Solove Research Institute *Douglas E. Wood, MD/Vice Chair ¶ Fred Hutchinson Cancer Research Matthew A. Gubens, MD, MS † Karen Reckamp, MD, MS † ‡ Center/Seattle Cancer Care Alliance UCSF Helen Diller Family City of Hope Comprehensive Cancer Center Comprehensive Cancer Center Dara L. Aisner, MD, PhD ≠ Gregory J. Riely, MD, PhD † Þ University of Colorado Cancer Center Mark Hennon, MD ¶ Memorial Sloan Kettering Cancer Center Roswell Park Cancer Institute Wallace Akerley, MD † Steven E. Schild, MD § Huntsman Cancer Institute at the Leora Horn, MD, MSc † Mayo Clinic Cancer Center University of Utah Vanderbilt-Ingram Cancer Center Theresa A. Shapiro, MD, PhD ¥ Jessica Bauman, MD ‡ † Rudy P. Lackner, MD ¶ The Sidney Kimmel Comprehensive Fox Chase Cancer Center Fred & Pamela Buffett Cancer Center Cancer Center at Johns Hopkins Joe Y. Chang, MD, PhD § Michael Lanuti, MD ¶ James Stevenson, MD † The University of Texas Massachusetts General Hospital Cancer Center Case Comprehensive Cancer Center/ MD Anderson Cancer Center University Hospitals Seidman Cancer Center Ticiana A. Leal, MD † and Cleveland Clinic Taussig Cancer Institute Lucian R. Chirieac, MD ≠ University of Wisconsin Carbone Cancer Center Dana-Farber/ Scott J. Swanson, MD ¶ Brigham and Women’s Cancer Center Leah J. Leisch, MD Þ Dana-Farber/Brigham and Women’s University of Alabama at Birmingham Cancer Center Thomas A. D’Amico, MD ¶ Comprehensive Cancer Center Duke Cancer Institute Kurt Tauer, MD † Rogerio Lilenbaum, MD † St. Jude Children’s Research Hospital/ Malcolm M. DeCamp, MD ¶ Yale Cancer Center/Smilow Cancer Hospital University of Tennessee Health Science Center Robert H. Lurie Comprehensive Cancer Center of Northwestern University Jules Lin, MD ¶ Stephen C. Yang, MD ¶ University of Michigan The Sidney Kimmel Comprehensive Thomas J. Dilling, MD, MS § Comprehensive Cancer Center Cancer Center at Johns Hopkins Moffitt Cancer Center Billy W. Loo, Jr., MD, PhD § Michael Dobelbower, MD, PhD § Stanford Cancer Institute University of Alabama at Birmingham NCCN Comprehensive Cancer Center Renato Martins, MD, MPH † Kristina Gregory, RN, MSN, OCN Fred Hutchinson Cancer Research Center/ Miranda Hughes, PhD Seattle Cancer Care Alliance † Medical oncology ф Diagnostic/Interventional ¶ Surgery/Surgical oncology radiology Continue § Radiation oncology/Radiotherapy ¥ Patient advocate ≠ Pathology Þ Internal medicine ‡ Hematology/Hematology *Discussion Section Writing oncology Committee NCCN Guidelines Panel Disclosures Version 3.2018, 02/21/18 © National Comprehensive Cancer Network, Inc. 2018, All rights reserved. The NCCN Guidelines® and this illustration may not be reproduced in any form without the express written permission of NCCN®. Printed by Anton Kabakov on 3/5/2018 6:58:05 AM. For personal use only. Not approved for distribution. Copyright © 2018 National Comprehensive Cancer Network, Inc., All Rights Reserved. NCCN Guidelines Version 3.2018 Table of Contents NCCN Guidelines Index Table of Contents Non-Small Cell Lung Cancer Discussion NCCN Non-Small Cell Lung Cancer Panel Members Clinical Trials: NCCN believes that the best management for any patient Summary of Guidelines Updates with cancer is in a clinical trial. Lung Cancer Prevention and Screening (PREV-1) Participation in clinical trials is Clinical Presentation and Risk Assessment (DIAG-1) especially encouraged. Initial Evaluation and Clinical Stage (NSCL-1) Evaluation and Treatment: To find clinical trials online at NCCN • Stage I (T1abc-2a, N0), Stage II (T1abc-2abc, N1; T2b, N0), Member Institutions, click here: Stage IIB (T3, N0), and Stage IIIA (T3, N1) (NSCL-2) nccn.org/clinical_trials/physician.html. • Stage IIB (T3 invasion, N0) and Stage IIIA (T4 extension, N0-1; T3, N1) (NSCL-4) NCCN Categories of Evidence and • Stage IIIA (T1-2, N2); Stage IIIB (T3, N2); Consensus: All recommendations Separate Pulmonary Nodules (Stage IIB, IIIA, IV) (NSCL-7) are category 2A unless otherwise • Multiple Lung Cancers (NSCL-10) indicated. • Stage IIIB (T1-2, N3); Stage IIIC (T3, N3) (NSCL-11) • Stage IIIB (T4, N2); Stage IIIC (T4, N3); Stage IVA, M1a: Pleural or Pericardial Effusion (NSCL-12) See NCCN Categories of Evidence • Stage IVA, M1b: Limited Sites (NSCL-13) and Consensus. Surveillance After Completion of Definitive Therapy (NSCL-15) Therapy for Recurrence and Metastasis (NSCL-16) Systemic Therapy for Metastatic Disease (NSCL-17) Principles of Pathologic Review (NSCL-A) Principles of Surgical Therapy (NSCL-B) Principles of Radiation Therapy (NSCL-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 Targeted Agents for Patients with Genetic Alterations (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. ©2018. Version 3.2018, 02/21/18 © National Comprehensive Cancer Network, Inc. 2018, All rights reserved. The NCCN Guidelines® and this illustration may not be reproduced in any form without the express written permission of NCCN®. Printed by Anton Kabakov on 3/5/2018 6:58:05 AM. For personal use only. Not approved for distribution. Copyright © 2018 National Comprehensive Cancer Network, Inc., All Rights Reserved. NCCN Guidelines Version 3.2018 Updates NCCN Guidelines Index Table of Contents Non-Small Cell Lung Cancer Discussion Updates in Version 3.2018 of the NCCN Guidelines for Non-Small Cell Lung Cancer from Version 2.2018 include: DIAG-3 • Solitary part-solid nodule(s); sub-categories modified Persistent and solid component <6 mm Persistent and solid component ≥6 mm ◊ Sub-bullets added – If unchanged and solid component remains <6 mm, annual CT for 5 y – If solid component ≥6 mm, consider PET/CT or biopsy Updates in Version 2.2018 of the NCCN Guidelines for Non-Small Cell Lung Cancer from Version 1.2018 include: NSCL-4 and NSCL-6 • Added Stage IIIA (T4, N0-1) NSCL-17 • Testing results clarification added:EGFR , ALK, ROS1, BRAF negative or unknown, PD-L1<50% or unknown NSCL-J 2 of 4 and 3 of 4 • Footnote ** added: Carboplatin-based regimens are often used for patients with comorbidities or those who cannot tolerate cisplatin. MS-1 • The Discussion section has been updated to reflect the changes in the algorithm. Updates in Version 1.2018 of the NCCN Guidelines for Non-Small Cell Lung Cancer from Version 9.2017 include: Global: Staging updated throughout based on the AJCC Cancer Staging Manual, Eighth Edition (2016). DIAG-1 • The following bullets were moved from DIAG-2 and DIAG-3 to DIAG-1 and added to the algorithm. Lung nodules in asymptomatic, high-risk patients detected during lung cancer screening with LDCT, see the NCCN Guidelines for Lung Cancer Screening. For incidentally detected lung nodules, see below DIAG-2 • The management of a solid nodule(s) on chest CT was modified based on the updated Fleischner criteria. MacMahon H, Naidich DP, Goo JM, et al. Guidelines for management of incidental pulmonary nodules detected on CT scans: From the Fleischner Society. Radiology 2017;284:228-243. DIAG-3 • The management of a subsolid nodule(s) on chest CT was modified based on the updated Fleischner criteria. MacMahon H, Naidich DP, Goo JM, et al. Guidelines for management of incidental pulmonary nodules detected on CT scans: From the Fleischner Society. Radiology 2017;284:228-243. Version 3.2018, 02/21/18 © National Comprehensive Cancer Network, Inc. 2018, All rights reserved. The NCCN Guidelines® and this illustration may not be reproduced in any form without the express written permission of NCCN®. UPDATES Printed
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