NCCN Issues Update to NSCLC Treatment Guidelines

07/18/17

The National Cancer Comprehensive Network (NCCN) has updated their treatment guidelines for non-small cell lung cancer (NSCLC) to include recommendations for BRAF mutation testing to guide therapy and a new first-line treatment option for non-squamous NSCLC.

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The guidelines are backed by a panel of 35 prominent oncologists and NCCN officials. Researchers utilized the PubMed database to identify 176 clinically relevant publications as part of their literature review for updating this guideline.

The most recent guideline updates include recommended BRAF-mutation testing for patients with adenocarcinoma or squamous cell carcinoma of the lungs.

For patients with lung cancer tested positive for BRAF V600E mutation, the newly recommended first-line therapy involves dabrafenib plus trametinib or previously recommended options. If progression on dabrafenib plus trametinib occurs, the guideline panel recommends previously recommended first-line therapy options. If progression on these first-line therapy options occurs, the panel recommends dabrafenib plus trametinib.

Additionally, the guideline suggests that in the event of dabrafenib plus trametinib not being tolerated, single-agent vemurafenib or dabrafenib should be administered.

Another update to the guideline is the addition of pembrolizumab, carboplatin, and pemetrexed as a new first-line systemic therapy option for patients with advanced non-squamous NSCLC (category 2A). The addition was based on FDA approval and a recent phase 2 study showing an improved objective response rate versus chemotherapy alone. Positive PD-L1 expression levels were not required for treatment in the study; however, patients with PD-L1 expression of 50% or more who received pembrolizumab plus chemotherapy had higher response rates.—Zachary Bessette