NCCN Updates NSCLC, Lung Cancer Screening Guidelines

01/30/18

The National Comprehensive Cancer Network (NCCN) modified their guidelines for both non-small cell lung cancer (NSCLC) and lung cancer screening to reflect new staging designations and testing results.

A few updates in the guidelines for NSCLC were made including the addition of stage IIIA (T4, N0-1) disease as a clinical evaluation characterization. Patients with stage IIIA (T4, N0-1) disease should begin initial treatment with either concurrent chemoradiation or chemotherapy, followed by surgery, according to the guidelines. In the adjuvant setting, patients with negative margins should be observed, while those with positive margins should undergo reresection. Active surveillance is recommended for patients with both types of margins.

As for metastatic NSCLC, a few testing results were added: EGFR, ALK, ROS1, BRAF negative or unknown, and PD-L1 < 50% or unknown.

A footnote was added to the section for systemic therapy for advanced or metastatic disease: “Carboplatin-based regimens are often used for patients with comorbidities or those who cannot tolerate cisplatin.”

One minor change was made to the guidelines for lung cancer screening. In the section for evaluation of screening findings and follow-up screening findings, the footnote for criteria for suspicion of malignancy was modified. “Higher than the background of surrounding lung parenchyma” was removed and the footnote now reads, “Hypermetabolism greater than the adjacent mediastinal blood pool, regardless of absolute SUV.”

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In both guidelines, the discussion section was updated to reflect the changes in the algorithm.—Zachary Bessette