NCCN.org/patients/surveyPlease complete our online survey at NCCN Guidelines for Patients® Version 1.2016 Lung Cancer NON–SMALL CELL LUNG CANCER Presented with support from: Available online at NCCN.org/patients Ü NCCN Guidelines for Patients® Version 1.2016 Lung Cancer NON-SMALL CELL LUNG CANCER Learning that you have cancer can be overwhelming. The goal of this book is to help you get the best cancer treatment. It explains which cancer tests and treatments are recommended by experts of non-small cell lung cancer. The National Comprehensive Cancer Network® (NCCN®) is a not-for-profit alliance of 27 of the world’s leading cancer centers. Experts from NCCN have written treatment guidelines for doctors who treat lung cancer. These treatment guidelines suggest what the best practice is for cancer care. The information in this patient book is based on the guidelines written for doctors. This book focuses on the treatment of non-small cell lung cancer. Key points of the book are summarized in the related NCCN Quick Guide™. NCCN also offers patient resources on lung cancer screening as well as other cancer types. Visit NCCN.org/patients for the full library of patient books, summaries, and other patient and caregiver resources. ® NCCN Guidelines for Patients i Lung Cancer – Non-Small Cell, Version 1.2016 Endorsers and sponsors Endorsed and sponsored in part by LUNG CANCER ALLIANCE LUNG CANCER RESEARCH COUNCIL Lung Cancer Alliance is proud to collaborate with National Comprehensive As an organization that seeks to increase public awareness and Cancer Network to sponsor and endorse these NCCN Guidelines for understanding about lung cancer and support programs for screening and Patients®: Non–Small Cell Lung Cancer. www.lungcanceralliance.org early detection, the Lung Cancer Research Council strongly supports and endorses these NCCN Guidelines for Patients. www.lungcancerresearchcouncil.org Endorsed by AMERICAN LUNG ASSOCIATION The American Lung Association strongly supports efforts to help ensure FREE TO BREATHE all patients facing lung cancer get the highest standard of treatment and When a patient or loved one is diagnosed with lung cancer, it is important care. Helping patients understand treatment guidelines is one important to know what treatments are available to them. These NCCN Guidelines for step in empowering them to get the care they want and need. That is why Patients will help patients and their caregivers locate the information they we are pleased to endorse NCCN’S efforts to provide accessible treatment need to help determine the best treatment option for them. guidelines and information to patients through the NCCN Guidelines for www.freetobreathe.org Patients. www.Lung.org. LUNG CANCER CIRCLE OF HOPE BONNIE J. ADDARIO LUNG CANCER FOUNDATION Lung Cancer Circle of Hope (LCCH) emphatically endorses the NCCN The Bonnie J. Addario Lung Cancer Foundation is proud to endorse these Guidelines for Patients. Knowledge is power and with this comprehensive NCCN Guidelines for Patients. We believe that educated and empowered resource, patients and their families can proactively work with a qualified patients do better and live longer. This book should be in the hands of every physician to make informed decisions in the battle to conquer cancer. patient diagnosed with lung cancer. www.lungcancerfoundation.org. www.lungcancercircleofhope.org CARING AMBASSADORS LUNG CANCER INITIatIVE OF NORTH CAROLINA The Caring Ambassador Lung Cancer Program is pleased to endorse these As an organization specializing in connecting patients, survivors and loved NCCN Guidelines for Patients: Lung Cancer. Patients and their loved ones ones with the medical research community, the Lung Cancer Initiative of need reliable resources to achieve the best possible outcomes for their NC fully supports tehse NCCN Guidelines for Patients. These guidelines disease. This resource provides just that. www.lungcancercap.org. set the standard for patient education and access to care. www.lungcancerinitiativenc.org DUSTY JOY foundatION With patients’ best interest at heart, NCCN defines the standard of care for LUNGEVITY FOUNDATION patients and physicians through proven scientific methods and expectations LUNGevity Foundation supports the NCCN Guidelines for Patients as an for new discoveries leading to improved patient outcomes. As a lung cancer excellent resource, as we strongly believe in providing education for all advocacy nonprofit, our organization wholeheartedly supports NCCN those affected by the disease. www.LUNGevity.org Guidelines for Patients. www.LiveLung.org. FREE ME FROM LUNG CANCER As a lung cancer survivor and President and CEO of Free ME from Lung Cancer, I am pleased to endorse this vitally important resource so that lung cancer patients can have the information needed to make informed decisions about their treatment. www.freeMEfromLungCancer.org. ® NCCN Guidelines for Patients ii Lung Cancer – Non-Small Cell, Version 1.2016 Turning tragedy into action DANA REEVE HAD IT ALL. She was a beautiful woman, an actress who married “Superman” actor Christopher Reeve. They had a son, Will. Then, in 1995, Christopher Reeve suffered a catastrophic injury in a riding accident and was paralyzed from the neck down. Dana cared for him for almost 10 years, tirelessly crusading for research on paralysis and stem cells. Christopher Reeve died in 2004, but Dana pressed forward with her foundation and with raising their son, then an adolescent. Just a few months later, this vibrant, healthy, non-smoking Dana Reeve young woman was diagnosed with stage IV lung cancer. She lived for just seven months. Dana Reeve was my sister, and until Dana was diagnosed, I didn't understand how hard it can be for patients to find good information about their treatment options. I am a third- generation physician, pathologist, and an oncology researcher. After Dana's death, I began working with lung cancer advocacy groups to raise awareness of the needs of lung cancer patients. I began to realize that the overall understanding of lung cancer is very naive. People just don't understand the breadth and scope of the problem. In 2009, I joined NCCN after being asked to participate in the Roundtable discussion that opened the NCCN Annual Conference that year. That first acquaintance with NCCN struck a strong chord in me. When I was asked to join the newly formed NCCN Foundation Board one year later, I gladly accepted. And when they decided to dedicate the NCCN Guidelines for Patients®: Lung Cancer in memory of my sister, I was thrilled. NCCN plays a critical role in translating complicated treatment information into easily understandable patient resources. I use NCCN's clinical guidelines regularly, and know there is a tremendous need for patient-friendly versions. The more that this information gets into the hands of patients, the more patients can feed it back to their doctors and make informed decisions for themselves. NCCN Guidelines for Patients® are a powerful resource. - Debora Morosini, MD Sister of Dana Reeve Member, NCCN Foundation Board of Directors ® NCCN Guidelines for Patients 1 Lung Cancer – Non-Small Cell, Version 1.2016 Credits NCCN aims to improve the care given to patients with cancer. NCCN staff work with experts to create helpful programs and resources for many stakeholders. Stakeholders include health providers, patients, businesses, and others. One resource is the series of books for patients called the NCCN Guidelines for Patients®. Each book presents the best practice for a type of cancer. The patient books are based on clinical practice guidelines written for cancer doctors. These guidelines are called the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®). Clinical practice guidelines list the best health care options for groups of patients. Many doctors use them to help plan cancer treatment for their patients. Panels of experts create the NCCN Guidelines®. Most of the experts are from NCCN Member Institutions. Panelists may include surgeons, radiation oncologists, medical oncologists, and patient advocates. Recommendations in the NCCN Guidelines are based on clinical trials and the experience of the panelists. The NCCN Guidelines are updated at least once a year. When funded, the patient books are updated to reflect the most recent version of the NCCN Guidelines for doctors. For more information about the NCCN Guidelines, visit NCCN.org/clinical.asp. NCCN staff involved in developing the NCCN Guidelines for Patients include: Dorothy A. Shead, MS Alycia Corrigan Susan Kidney Director, Patient and Clinical Information Medical Writer Graphic Design Specialist Operations Rachael Clarke Laura J. Hanisch, PsyD Guidelines Data and Layout Coordinator Medical Writer/Patient Information Specialist Supported by NCCN Foundation® NCCN Foundation supports the mission of the National Comprehensive Cancer Network® (NCCN®) to improve the care of patients with cancer. One of its aims is to raise funds to create a library of books for patients. Learn more about the NCCN Foundation at NCCN.org/foundation. National Comprehensive Cancer Network (NCCN) 275 Commerce Drive • Suite 300 Fort Washington, PA 19034 215.690.0300 © 2016 National Comprehensive Cancer Network, Inc. All rights reserved. The NCCN Guidelines for Patients® and illustrations herein may not be reproduced in any form for any purpose without the express written permission of NCCN. ® NCCN Guidelines for Patients 2 Lung Cancer – Non-Small Cell, Version 1.2016 Contents Lung Cancer NON-SMALL CELL LUNG CANCER 4 How to use this book 59 Part 6 Treatment guide: One 5 Part 1 primary tumor Lung cancer basics Presents treatment options for one or more Explains where lung cancer starts and how related masses of cancer cells. it spreads. 93 Part 7 11 Part 2 Treatment guide: Multiple Assessing lung nodules primary tumors Discusses care for when a small lung mass Presents treatment options for two or more is found. unrelated masses of cancer cells. 21 Part 3 103 Part 8 Cancer staging Making treatment decisions Defines the groups of lung cancer used for Offers tips for choosing the best treatment.