NCCN Annual Conference 2018: Updated Guidelines for NSCLC
Posted: Thursday, April 12, 2018
Updates for the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Non–Small Cell Lung Cancer incorporated new first-line targeted therapies, including the third-generation EGFR tyrosine kinase inhibitor osimertinib and the ALK inhibitor alectinib. Karen L. Reckamp, MD, MS, of the City of Hope Comprehensive Cancer Center in Duarte, California, presented the updates at the 2018 NCCN Annual Conference in Orlando.
Molecular testing, including PD-L1 testing, is now recommended for first initial diagnosis. In addition, for adenocarcinoma, testing is recommended for EGFR, ALK, ROS1, and BRAF mutations as part of broad molecular profiling.
With emerging research and data, from the ALEX and J-ALEX trials, the biggest change in the Guidelines centers on the recommendation of alectinib as the primary first-line therapy over crizotinib or ceritinib. Patients treated with alectinib showed improved progression-free survival compared with crizotinib, regardless of the presence of brain metastases.
Osimertinib is the newest addition to the list of approved first-line therapies, which includes erlotinib, afatinib, and gefitinib, for patients with EGFR mutations. The Guidelines include some recommendations on treatment sequencing. When brain-only metastasis is present, local therapy, osimertinib, erlotinib, or gefitinib, is recommended. However, osimertinib is recommended if the T790M mutation is present and multiple metastatic lesions occur.
In the presence of other mutations, such as ROS1 rearrangements, the updated Guidelines consider crizotinib as the preferred treatment, although ceritinib can also be used. Encouraging results have also been observed with the combination of dabrafenib and trametinib for BRAF mutations, and this regimen has been added to the Guidelines as well.
Visit nccn.org for the complete updated NCCN Guidelines for Non–Small Cell Lung Cancer.
