Interpretation of the updated NCCN clinical practice guidelines in oncology: Non-small cell lung cancer (version 5. 2024)_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LUO Guoqing ¹ , LU Xiao ¹ , LI Dinghui ¹ , PENG Min ² ,  LI Ning ¹ ,  GENG Qing ¹

1. Department of Thoracic Surgery, Renmin Hospital of Wuhan University, Wuhan, 430060, P. R. China;
2. Department of Oncology, Renmin Hospital of Wuhan University, Wuhan, 430060, P. R. China;

Corresponding author：

LI Ning, Email: md.lining@whu.edu.cn; GENG Qing, Email: gengqingwhu@whu.edu.cn

Keywords：

Non-small cell lung cancer; NCCN guidelines; immunotherapy; targeted therapy; guideline interpretation

DOI：

10.7507/1007-4848.202405046

Video：

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Lung cancer is the leading cause of cancer-related deaths worldwide, especially non-small cell lung cancer (NSCLC). With the popularization of low-dose CT and the improvement of people’s awareness of physical examinations, the number of detected pulmonary nodules is gradually increasing, and there is a greater demand for standardized diagnostic and treatment guidelines. On April 23, 2024, the National Comprehensive Cancer Network updated its clinical practice guidelines for NSCLC to the version 5. Compared with the version 5 in 2023, the version 5 in 2024 updates focus on diagnostic evaluation, perioperative systemic therapy, treatment of advanced NSCLC, and molecular marker testing, which will be interpreted in this article with the aim of providing the latest guidance and reference for the diagnosis and treatment of lung cancer in China.

Citation： LUO Guoqing, LU Xiao, LI Dinghui, PENG Min, LI Ning, GENG Qing. Interpretation of the updated NCCN clinical practice guidelines in oncology: Non-small cell lung cancer (version 5. 2024). Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2024, 31(7): 955-961. doi: 10.7507/1007-4848.202405046 Copy

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2.	Zheng RS, Chen R, Han BF, et al. Cancer incidence and mortality in China, 2022. Zhonghua Zhong Liu Za Zhi, 2024, 46(3): 221-231.
3.	Herbst RS, Garon EB, Kim DW, et al. Five year survival update from KEYNOTE-010: Pembrolizumab versus docetaxel for previously treated, programmed death-ligand 1-positive advanced NSCLC. J Thorac Oncol, 2021, 16(10): 1718-1732.
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5.	Mazieres J, Drilon A, Lusque A, et al. Immune checkpoint inhibitors for patients with advanced lung cancer and oncogenic driver alterations: Results from the IMMUNOTARGET registry. Ann Oncol, 2019, 30(8): 1321-1328.
6.	Ramalingam SS, Vansteenkiste J, Planchard D, et al. Overall survival with osimertinib in untreated, EGFR-mutated advanced NSCLC. N Engl J Med, 2020, 382(1): 41-50.
7.	Bradbury P, Sivajohanathan D, Chan A, et al. Postoperative adjuvant systemic therapy in completely resected non-small-cell lung cancer: A systematic review. Clin Lung Cancer, 2017, 18(3): 259-273.
8.	Wu YL, Dziadziuszko R, Ahn JS, et al. Alectinib in resected ALK-positive non-small-cell lung cancer. N Engl J Med, 2024, 390(14): 1265-1276.
9.	Wu YL, Tsuboi M, He J, et al. Osimertinib in resected EGFR-mutated non-small-cell lung cancer. N Engl J Med, 2020, 383(18): 1711-1723.
10.	Wakelee H, Liberman M, Kato T, et al. Perioperative pembrolizumab for early-stage non-small-cell lung cancer. N Engl J Med, 2023, 389(6): 491-503.
11.	Planchard D, Jänne PA, Cheng Y, et al. Osimertinib with or without chemotherapy in EGFR-mutated advanced NSCLC. N Engl J Med, 2023, 389(21): 1935-1948.
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14.	Zhou C, Tang KJ, Cho BC, et al. Amivantamab plus chemotherapy in NSCLC with EGFR exon 20 insertions. N Engl J Med, 2023, 389(22): 2039-2051.
15.	Slebos RJ, Hruban RH, Dalesio O, et al. Relationship between K-ras oncogene activation and smoking in adenocarcinoma of the human lung. J Natl Cancer Inst, 1991, 83(14): 1024-1027.
16.	Eberhard DA, Johnson BE, Amler LC, et al. Mutations in the epidermal growth factor receptor and in KRAS are predictive and prognostic indicators in patients with non-small-cell lung cancer treated with chemotherapy alone and in combination with erlotinib. J Clin Oncol, 2005, 23(25): 5900-5909.
17.	朱玲玲, 王艇, 伍娟, 等. 2023年第3版《NCCN肿瘤临床实践指南: 非小细胞肺癌》更新解读. 中国肺癌杂志, 2023, 26(6): 407-415.
18.	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.
19.	Shaw AT, Ou SH, Bang YJ, et al. Crizotinib in ROS1-rearranged non-small-cell lung cancer. N Engl J Med, 2014, 371(21): 1963-1971.
20.	Drilon A, Ou SI, Cho BC, et al. Repotrectinib (TPX-0005) is a next-generation ROS1/TRK/ALK inhibitor that potently inhibits ROS1/TRK/ALK solvent-front mutations. Cancer Discov, 2018, 8(10): 1227-1236.
21.	Drilon A, Camidge DR, Lin JJ, et al. Repotrectinib in ROS1 fusion-positive non-small-cell lung cancer. N Engl J Med, 2024, 390(2): 118-131.
22.	Meric-Bernstam F, Makker V, Oaknin A, et al. Efficacy and safety of trastuzumab deruxtecan in patients with HER2-expressing solid tumors: Primary results from the DESTINY-PanTumor02 phaseⅡtrial. J Clin Oncol, 2024, 42(1): 47-58.
23.	Smit EF, Felip E, Uprety D, et al. Trastuzumab deruxtecan in patients with metastatic non-small-cell lung cancer (DESTINY-Lung01): Primary results of the HER2-overexpressing cohorts from a single-arm, phase 2 trial. Lancet Oncol, 2024, 25(4): 439-454.
24.	Raghav KPS, Siena S, Takashima A, et al. Trastuzumab deruxtecan (T-DXd) in patients (pts) with HER2-overexpressing/amplified (HER2+) metastatic colorectal cancer (mCRC): Primary results from the multicenter, randomized, phase 2 DESTINY-CRC02 study. J Clin Oncol, 2023, 41: 3501.
25.	Gogishvili M, Melkadze T, Makharadze T, et al. Cemiplimab plus chemotherapy versus chemotherapy alone in non-small cell lung cancer: A randomized, controlled, double-blind phase 3 trial. Nat Med, 2022, 28(11): 2374-2380.
26.	Leichsenring J, Horak P, Kreutzfeldt S, et al. Variant classification in precision oncology. Int J Cancer, 2019, 145(11): 2996-3010.

1. Siegel RL, Giaquinto AN, Jemal A. Cancer statistics, 2024. CA Cancer J Clin, 2024, 74(1): 12-49.
2. Zheng RS, Chen R, Han BF, et al. Cancer incidence and mortality in China, 2022. Zhonghua Zhong Liu Za Zhi, 2024, 46(3): 221-231.
3. Herbst RS, Garon EB, Kim DW, et al. Five year survival update from KEYNOTE-010: Pembrolizumab versus docetaxel for previously treated, programmed death-ligand 1-positive advanced NSCLC. J Thorac Oncol, 2021, 16(10): 1718-1732.
4. NCCN. NCCN clinical practice guidelines in oncology: Non-small cell lung cancer version 5.2024. URL: https://www. nccn.org/.
5. Mazieres J, Drilon A, Lusque A, et al. Immune checkpoint inhibitors for patients with advanced lung cancer and oncogenic driver alterations: Results from the IMMUNOTARGET registry. Ann Oncol, 2019, 30(8): 1321-1328.
6. Ramalingam SS, Vansteenkiste J, Planchard D, et al. Overall survival with osimertinib in untreated, EGFR-mutated advanced NSCLC. N Engl J Med, 2020, 382(1): 41-50.
7. Bradbury P, Sivajohanathan D, Chan A, et al. Postoperative adjuvant systemic therapy in completely resected non-small-cell lung cancer: A systematic review. Clin Lung Cancer, 2017, 18(3): 259-273.
8. Wu YL, Dziadziuszko R, Ahn JS, et al. Alectinib in resected ALK-positive non-small-cell lung cancer. N Engl J Med, 2024, 390(14): 1265-1276.
9. Wu YL, Tsuboi M, He J, et al. Osimertinib in resected EGFR-mutated non-small-cell lung cancer. N Engl J Med, 2020, 383(18): 1711-1723.
10. Wakelee H, Liberman M, Kato T, et al. Perioperative pembrolizumab for early-stage non-small-cell lung cancer. N Engl J Med, 2023, 389(6): 491-503.
11. Planchard D, Jänne PA, Cheng Y, et al. Osimertinib with or without chemotherapy in EGFR-mutated advanced NSCLC. N Engl J Med, 2023, 389(21): 1935-1948.
12. Syed YY. Amivantamab: First approval. Drugs, 2021, 81(11): 1349-1353.
13. Passaro A, Wang J, Wang Y, et al. Amivantamab plus chemotherapy with and without lazertinib in EGFR-mutant advanced NSCLC after disease progression on osimertinib: Primary results from the phase Ⅲ MARIPOSA-2 study. Ann Oncol, 2024, 35(1): 77-90.
14. Zhou C, Tang KJ, Cho BC, et al. Amivantamab plus chemotherapy in NSCLC with EGFR exon 20 insertions. N Engl J Med, 2023, 389(22): 2039-2051.
15. Slebos RJ, Hruban RH, Dalesio O, et al. Relationship between K-ras oncogene activation and smoking in adenocarcinoma of the human lung. J Natl Cancer Inst, 1991, 83(14): 1024-1027.
16. Eberhard DA, Johnson BE, Amler LC, et al. Mutations in the epidermal growth factor receptor and in KRAS are predictive and prognostic indicators in patients with non-small-cell lung cancer treated with chemotherapy alone and in combination with erlotinib. J Clin Oncol, 2005, 23(25): 5900-5909.
17. 朱玲玲, 王艇, 伍娟, 等. 2023年第3版《NCCN肿瘤临床实践指南: 非小细胞肺癌》更新解读. 中国肺癌杂志, 2023, 26(6): 407-415.
18. 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.
19. Shaw AT, Ou SH, Bang YJ, et al. Crizotinib in ROS1-rearranged non-small-cell lung cancer. N Engl J Med, 2014, 371(21): 1963-1971.
20. Drilon A, Ou SI, Cho BC, et al. Repotrectinib (TPX-0005) is a next-generation ROS1/TRK/ALK inhibitor that potently inhibits ROS1/TRK/ALK solvent-front mutations. Cancer Discov, 2018, 8(10): 1227-1236.
21. Drilon A, Camidge DR, Lin JJ, et al. Repotrectinib in ROS1 fusion-positive non-small-cell lung cancer. N Engl J Med, 2024, 390(2): 118-131.
22. Meric-Bernstam F, Makker V, Oaknin A, et al. Efficacy and safety of trastuzumab deruxtecan in patients with HER2-expressing solid tumors: Primary results from the DESTINY-PanTumor02 phaseⅡtrial. J Clin Oncol, 2024, 42(1): 47-58.
23. Smit EF, Felip E, Uprety D, et al. Trastuzumab deruxtecan in patients with metastatic non-small-cell lung cancer (DESTINY-Lung01): Primary results of the HER2-overexpressing cohorts from a single-arm, phase 2 trial. Lancet Oncol, 2024, 25(4): 439-454.
24. Raghav KPS, Siena S, Takashima A, et al. Trastuzumab deruxtecan (T-DXd) in patients (pts) with HER2-overexpressing/amplified (HER2+) metastatic colorectal cancer (mCRC): Primary results from the multicenter, randomized, phase 2 DESTINY-CRC02 study. J Clin Oncol, 2023, 41: 3501.
25. Gogishvili M, Melkadze T, Makharadze T, et al. Cemiplimab plus chemotherapy versus chemotherapy alone in non-small cell lung cancer: A randomized, controlled, double-blind phase 3 trial. Nat Med, 2022, 28(11): 2374-2380.
26. Leichsenring J, Horak P, Kreutzfeldt S, et al. Variant classification in precision oncology. Int J Cancer, 2019, 145(11): 2996-3010.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Interpretation of the updated NCCN clinical practice guidelines in oncology: Non-small cell lung cancer (version 5. 2024)

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