Interpretation of updated NCCN guidelines for non-small cell lung cancer (version 1, 2022)_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

JIAN Zheng , CHEN Xueyu , ZHANG Yajie ,  LI Hecheng

Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, P. R. China;

Corresponding author：

LI Hecheng, Email: lihecheng2000@hotmail.com

Keywords：

Non-small cell lung cancer; NCCN guidelines; update of guideline; interpretation of guideline

DOI：

10.7507/1007-4848.202112081

Video：

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The National Comprehensive Cancer Network (NCCN) has updated and released the latest content of the NCCN guidelines for the clinical diagnosis and treatment of non-small cell lung cancer (NSCLC) in the version 1, 2022. Based on high-quality clinical evidence and the latest research progress of the diagnosis and treatment of NSCLC, the guidelines have been widely recognized and welcomed by clinicians around the world. Compared with the version 7, 2021, the new version has been updated and revised in some parts of chapters and sections, mainly focusing on targeted therapies and molecular testing. This article will interpret the updated therapy content of the new version.

Citation： JIAN Zheng, CHEN Xueyu, ZHANG Yajie, LI Hecheng. Interpretation of updated NCCN guidelines for non-small cell lung cancer (version 1, 2022). Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2022, 29(2): 150-157. doi: 10.7507/1007-4848.202112081 Copy

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2.	Wang M, Herbst RS, Boshoff C. Toward personalized treatment approaches for non-small-cell lung cancer. Nat Med, 2021, 27(8): 1345-1356.
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4.	Chen AC, Gillespie CT. Robotic endoscopic airway challenge: REACH assessment. Ann Thorac Surg, 2018, 106(1): 293-297.
5.	Chen AC, Pastis NJ, Mahajan AK, et al. Robotic bronchoscopy for peripheral pulmonary lesions: A multicenter pilot and feasibility study (BENEFIT). Chest, 2021, 159(2): 845-852.
6.	Sehgal IS, Dhooria S, Aggarwal AN, et al. Impact of rapid on-site cytological evaluation (ROSE) on the diagnostic yield of transbronchial needle aspiration during mediastinal lymph node sampling: Systematic review and meta-analysis. Chest, 2018, 153(4): 929-938.
7.	Leong D, Rai R, Nguyen B, et al. Advances in adjuvant systemic therapy for non-small-cell lung cancer. World J Clin Oncol, 2014, 5(4): 633-645.
8.	Saw SPL, Ong BH, Chua KLM, et al. Revisiting neoadjuvant therapy in non-small-cell lung cancer. Lancet Oncol, 2021, 22(11): e501-e516.
9.	. Recondo G, Facchinetti F, Olaussen KA, et al. Making the first move in EGFR-driven or ALK-driven NSCLC: First-generation or next-generation TKI? Nat Rev Clin Oncol 2018, 15(11): 694-708.
10.	Gianni C, Bronte G, Delmonte A, et al. Case report: Stevens-Johnson syndrome and hepatotoxicity induced by osimertinib sequential to pembrolizumab in a patient with EGFR-mutated lung adenocarcinoma. Front Pharmacol, 2021, 12: 672233.
11.	Schoenfeld AJ, Arbour KC, Rizvi H, et al. Severe immune-related adverse events are common with sequential PD-(L)1 blockade and osimertinib. Ann Oncol, 2019, 30(5): 839-844.
12.	Westover D, Zugazagoitia J, Cho BC, et al. Mechanisms of acquired resistance to first- and second-generation EGFR tyrosine kinase inhibitors. Ann Oncol, 2018, 29(suppl_1): i10-i19.
13.	Kobayashi Y, Fujino T, Nishino M, et al. EGFR T790M and C797S mutations as mechanisms of acquired resistance to dacomitinib. J Thorac Oncol, 2018, 13(5): 727-731.
14.	Thai AA, Solomon BJ, Sequist LV, et al. Lung cancer. Lancet, 2021, 398(10299): 535-554.
15.	Peled N, Gillis R, Kilickap S, et al. GLASS: Global lorlatinib for ALK(+) and ROS1(+) retrospective study: Real world data of 123 NSCLC patients. Lung Cancer, 2020, 148: 48-54.
16.	Shaw AT, Bauer TM, de Marinis F, et al. First-line lorlatinib or crizotinib in advanced alk-positive lung cancer. N Engl J Med, 2020, 383(21): 2018-2029.
17.	Planchard D, Smit EF, Groen HJM, et al. Dabrafenib plus trametinib in patients with previously untreated BRAF V600E-mutant metastatic non-small-cell lung cancer: An open-label, phase 2 trial. Lancet Oncol, 2017, 18(10): 1307-1316.
18.	Planchard D, Besse B, Groen HJM, et al. Phase 2 study of dabrafenib plus trametinib in patients with BRAF V600E-mutant metastatic NSCLC: Updated 5-year survival rates and genomic analysis. J Thorac Oncol, 2022, 17(1): 103-115.
19.	Tan AC, Seet AOL, Lai GGY, et al. Molecular characterization and clinical outcomes in RET-rearranged NSCLC. J Thorac Oncol, 2020, 15(12): 1928-1934.
20.	Yoh K, Seto T, Satouchi M, et al. Vandetanib in patients with previously treated RET-rearranged advanced non-small-cell lung cancer (LURET): An open-label, multicentre phase 2 trial. Lancet Respir Med, 2017, 5(1): 42-50.
21.	Li BT, Smit EF, Goto Y, et al. Trastuzumab deruxtecan in HER2-mutant non-small-cell lung cancer. N Engl J Med, 2021. [Epub ahead of print].
22.	Wolff HB, Alberts L, Kastelijn EA, et al. Differences in longitudinal health utility between stereotactic body radiation therapy and surgery in stage Ⅰ non-small cell lung cancer. J Thorac Oncol, 2018, 13(5): 689-698.
23.	Chang JY, Senan S, Paul MA, et al. Stereotactic ablative radiotherapy versus lobectomy for operable stage Ⅰ non-small-cell lung cancer: A pooled analysis of two randomised trials. Lancet Oncol, 2015, 16(6): 630-637.
24.	Brooks ED, Verma V, Senan S, et al. Salvage therapy for locoregional recurrence after stereotactic ablative radiotherapy for early-stage NSCLC. J Thorac Oncol, 2020, 15(2): 176-189.
25.	Kong FM, Ten Haken RK, Schipper M, et al. Effect of midtreatment PET/CT-adapted radiation therapy with concurrent chemotherapy in patients with locally advanced non-small-cell lung cancer: A phase 2 clinical trial. JAMA Oncol, 2017, 3(10): 1358-1365.
26.	Theelen WSME, Chen D, Verma V, et al. Pembrolizumab with or without radiotherapy for metastatic non-small-cell lung cancer: A pooled analysis of two randomised trials. Lancet Respir Med, 2021, 9(5): 467-475.
27.	Páez-Carpio A, Gómez FM, Isus Olivé G, et al. Image-guided percutaneous ablation for the treatment of lung malignancies: Current state of the art. Insights Imaging, 2021, 12(1): 57.
28.	Genshaft SJ, Suh RD, Abtin F, et al. Society of Interventional Radiology Quality Improvement standards on percutaneous ablation of non-small cell lung cancer and metastatic disease to the lungs. J Vasc Interv Radiol, 2021, 32(8): 1242.e1-1242.e10.
29.	Vasconcelos PENS, Gergis C, Viray H, et al. EGFR-A763_Y764insFQEA is a unique exon 20 insertion mutation that displays sensitivity to approved and in-development lung cancer EGFR tyrosine kinase inhibitors. JTO Clin Res Rep, 2020, 1(3): 100051.
30.	Yasuda H, Park E, Yun CH, et al. Structural, biochemical, and clinical characterization of epidermal growth factor receptor (EGFR) exon 20 insertion mutations in lung cancer. Sci Transl Med, 2013, 5(216): 216ra177.
31.	Meador CB, Sequist LV, Piotrowska Z. Targeting EGFR exon 20 insertions in non-small cell lung cancer: Recent advances and clinical updates. Cancer Discov, 2021, 11(9): 2145-2157.
32.	Remon J, Hendriks LEL, Cardona AF, et al. EGFR exon 20 insertions in advanced non-small cell lung cancer: A new history begins. Cancer Treat Rev, 2020, 90: 102105.
33.	Skoulidis F, Li BT, Dy GK, et al. Sotorasib for lung cancers with KRAS p. G12C mutation. N Engl J Med, 2021, 384(25): 2371-2381.
34.	Wolf J, Seto T, Han JY, et al. Capmatinib in MET exon 14-mutated or MET-amplified non-small-cell lung cancer. N Engl J Med, 2020, 383(10): 944-957.
35.	Khodakov D, Wang C, Zhang DY. Diagnostics based on nucleic acid sequence variant profiling: PCR, hybridization, and NGS approaches. Adv Drug Deliv Rev, 2016, 105(Pt A): 3-19.
36.	Tejerina E, Garca Tobar L, Echeveste JI, et al. PD-L1 in cytological samples: A review and a practical approach. Front Med (Lausanne), 2021, 8: 668612.
37.	Chae YK, Davis AA, Agte S, et al. Clinical implications of circulating tumor DNA tumor mutational burden (ctDNA TMB) in non-small cell lung cancer. Oncologist, 2019, 24(6): 820-828.
38.	Wang Z, Cheng Y, An T, et al. Detection of EGFR mutations in plasma circulating tumour DNA as a selection criterion for first-line gefitinib treatment in patients with advanced lung adenocarcinoma (BENEFIT): A phase 2, single-arm, multicentre clinical trial. Lancet Respir Med, 2018, 6(9): 681-690.

1. Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2021, 71(3): 209-249.
2. Wang M, Herbst RS, Boshoff C. Toward personalized treatment approaches for non-small-cell lung cancer. Nat Med, 2021, 27(8): 1345-1356.
3. NCCN non-small cell lung cancer panel members. NCCN guidelines for non-small cell lung cancer (version 1,2022).2022, 1-265. [2021-12-08] URL: https://www.nccn.org/professionals/physician_gls/pdf/nscl.pdf.
4. Chen AC, Gillespie CT. Robotic endoscopic airway challenge: REACH assessment. Ann Thorac Surg, 2018, 106(1): 293-297.
5. Chen AC, Pastis NJ, Mahajan AK, et al. Robotic bronchoscopy for peripheral pulmonary lesions: A multicenter pilot and feasibility study (BENEFIT). Chest, 2021, 159(2): 845-852.
6. Sehgal IS, Dhooria S, Aggarwal AN, et al. Impact of rapid on-site cytological evaluation (ROSE) on the diagnostic yield of transbronchial needle aspiration during mediastinal lymph node sampling: Systematic review and meta-analysis. Chest, 2018, 153(4): 929-938.
7. Leong D, Rai R, Nguyen B, et al. Advances in adjuvant systemic therapy for non-small-cell lung cancer. World J Clin Oncol, 2014, 5(4): 633-645.
8. Saw SPL, Ong BH, Chua KLM, et al. Revisiting neoadjuvant therapy in non-small-cell lung cancer. Lancet Oncol, 2021, 22(11): e501-e516.
9. . Recondo G, Facchinetti F, Olaussen KA, et al. Making the first move in EGFR-driven or ALK-driven NSCLC: First-generation or next-generation TKI? Nat Rev Clin Oncol 2018, 15(11): 694-708.
10. Gianni C, Bronte G, Delmonte A, et al. Case report: Stevens-Johnson syndrome and hepatotoxicity induced by osimertinib sequential to pembrolizumab in a patient with EGFR-mutated lung adenocarcinoma. Front Pharmacol, 2021, 12: 672233.
11. Schoenfeld AJ, Arbour KC, Rizvi H, et al. Severe immune-related adverse events are common with sequential PD-(L)1 blockade and osimertinib. Ann Oncol, 2019, 30(5): 839-844.
12. Westover D, Zugazagoitia J, Cho BC, et al. Mechanisms of acquired resistance to first- and second-generation EGFR tyrosine kinase inhibitors. Ann Oncol, 2018, 29(suppl_1): i10-i19.
13. Kobayashi Y, Fujino T, Nishino M, et al. EGFR T790M and C797S mutations as mechanisms of acquired resistance to dacomitinib. J Thorac Oncol, 2018, 13(5): 727-731.
14. Thai AA, Solomon BJ, Sequist LV, et al. Lung cancer. Lancet, 2021, 398(10299): 535-554.
15. Peled N, Gillis R, Kilickap S, et al. GLASS: Global lorlatinib for ALK(+) and ROS1(+) retrospective study: Real world data of 123 NSCLC patients. Lung Cancer, 2020, 148: 48-54.
16. Shaw AT, Bauer TM, de Marinis F, et al. First-line lorlatinib or crizotinib in advanced alk-positive lung cancer. N Engl J Med, 2020, 383(21): 2018-2029.
17. Planchard D, Smit EF, Groen HJM, et al. Dabrafenib plus trametinib in patients with previously untreated BRAF V600E-mutant metastatic non-small-cell lung cancer: An open-label, phase 2 trial. Lancet Oncol, 2017, 18(10): 1307-1316.
18. Planchard D, Besse B, Groen HJM, et al. Phase 2 study of dabrafenib plus trametinib in patients with BRAF V600E-mutant metastatic NSCLC: Updated 5-year survival rates and genomic analysis. J Thorac Oncol, 2022, 17(1): 103-115.
19. Tan AC, Seet AOL, Lai GGY, et al. Molecular characterization and clinical outcomes in RET-rearranged NSCLC. J Thorac Oncol, 2020, 15(12): 1928-1934.
20. Yoh K, Seto T, Satouchi M, et al. Vandetanib in patients with previously treated RET-rearranged advanced non-small-cell lung cancer (LURET): An open-label, multicentre phase 2 trial. Lancet Respir Med, 2017, 5(1): 42-50.
21. Li BT, Smit EF, Goto Y, et al. Trastuzumab deruxtecan in HER2-mutant non-small-cell lung cancer. N Engl J Med, 2021. [Epub ahead of print].
22. Wolff HB, Alberts L, Kastelijn EA, et al. Differences in longitudinal health utility between stereotactic body radiation therapy and surgery in stage Ⅰ non-small cell lung cancer. J Thorac Oncol, 2018, 13(5): 689-698.
23. Chang JY, Senan S, Paul MA, et al. Stereotactic ablative radiotherapy versus lobectomy for operable stage Ⅰ non-small-cell lung cancer: A pooled analysis of two randomised trials. Lancet Oncol, 2015, 16(6): 630-637.
24. Brooks ED, Verma V, Senan S, et al. Salvage therapy for locoregional recurrence after stereotactic ablative radiotherapy for early-stage NSCLC. J Thorac Oncol, 2020, 15(2): 176-189.
25. Kong FM, Ten Haken RK, Schipper M, et al. Effect of midtreatment PET/CT-adapted radiation therapy with concurrent chemotherapy in patients with locally advanced non-small-cell lung cancer: A phase 2 clinical trial. JAMA Oncol, 2017, 3(10): 1358-1365.
26. Theelen WSME, Chen D, Verma V, et al. Pembrolizumab with or without radiotherapy for metastatic non-small-cell lung cancer: A pooled analysis of two randomised trials. Lancet Respir Med, 2021, 9(5): 467-475.
27. Páez-Carpio A, Gómez FM, Isus Olivé G, et al. Image-guided percutaneous ablation for the treatment of lung malignancies: Current state of the art. Insights Imaging, 2021, 12(1): 57.
28. Genshaft SJ, Suh RD, Abtin F, et al. Society of Interventional Radiology Quality Improvement standards on percutaneous ablation of non-small cell lung cancer and metastatic disease to the lungs. J Vasc Interv Radiol, 2021, 32(8): 1242.e1-1242.e10.
29. Vasconcelos PENS, Gergis C, Viray H, et al. EGFR-A763_Y764insFQEA is a unique exon 20 insertion mutation that displays sensitivity to approved and in-development lung cancer EGFR tyrosine kinase inhibitors. JTO Clin Res Rep, 2020, 1(3): 100051.
30. Yasuda H, Park E, Yun CH, et al. Structural, biochemical, and clinical characterization of epidermal growth factor receptor (EGFR) exon 20 insertion mutations in lung cancer. Sci Transl Med, 2013, 5(216): 216ra177.
31. Meador CB, Sequist LV, Piotrowska Z. Targeting EGFR exon 20 insertions in non-small cell lung cancer: Recent advances and clinical updates. Cancer Discov, 2021, 11(9): 2145-2157.
32. Remon J, Hendriks LEL, Cardona AF, et al. EGFR exon 20 insertions in advanced non-small cell lung cancer: A new history begins. Cancer Treat Rev, 2020, 90: 102105.
33. Skoulidis F, Li BT, Dy GK, et al. Sotorasib for lung cancers with KRAS p. G12C mutation. N Engl J Med, 2021, 384(25): 2371-2381.
34. Wolf J, Seto T, Han JY, et al. Capmatinib in MET exon 14-mutated or MET-amplified non-small-cell lung cancer. N Engl J Med, 2020, 383(10): 944-957.
35. Khodakov D, Wang C, Zhang DY. Diagnostics based on nucleic acid sequence variant profiling: PCR, hybridization, and NGS approaches. Adv Drug Deliv Rev, 2016, 105(Pt A): 3-19.
36. Tejerina E, Garca Tobar L, Echeveste JI, et al. PD-L1 in cytological samples: A review and a practical approach. Front Med (Lausanne), 2021, 8: 668612.
37. Chae YK, Davis AA, Agte S, et al. Clinical implications of circulating tumor DNA tumor mutational burden (ctDNA TMB) in non-small cell lung cancer. Oncologist, 2019, 24(6): 820-828.
38. Wang Z, Cheng Y, An T, et al. Detection of EGFR mutations in plasma circulating tumour DNA as a selection criterion for first-line gefitinib treatment in patients with advanced lung adenocarcinoma (BENEFIT): A phase 2, single-arm, multicentre clinical trial. Lancet Respir Med, 2018, 6(9): 681-690.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Interpretation of updated NCCN guidelines for non-small cell lung cancer (version 1, 2022)

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