NCCN releases updated guidelines for NSCLC

  • Ettinger DS & al.
  • J Natl Compr Canc Netw
  • 1 Dec 2019

  • curated by Kelli Whitlock Burton
  • Univadis Clinical Summaries
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Takeaway

  • The National Comprehensive Cancer Network has released a 2020 guidelines update for the treatment of NSCLC that focuses on immunotherapy.

Why this matters

  • The update categorizes systemic therapies under a new stratification system: preferred, other recommended options, or useful under certain circumstances. The new headings do not replace the NCCN Categories of Evidence and Consensus.

Key additions

  • ROS1 rearrangements and BRAF mutations are added to the list of biomarkers that must be negative before immunotherapy.
  • Metastatic NSCLC with PD-L1 expression levels of ≥50% and targetable driver oncogene molecular alteration (e.g., EGFR, ALK, ROS1) should receive first-line therapy targeted at the specific oncogene instead of first-line pembrolizumab monotherapy.

Other key points

  • First-line therapies for certain patients with metastatic nonsquamous NSCLC are pembrolizumab/carboplatin (or cisplatin)/pemetrexed (category 1; preferred).
  • Pembrolizumab/chemotherapy is first-line therapy for metastatic nonsquamous NSCLC or NSCLC not otherwise specified with no contraindications to immunotherapy, or nonsquamous NSCLC negative for EGFR, ALK, ROS1, or BRAF alterations, regardless of PD-L1 expression levels (category 1; preferred).
  • For metastatic nonsquamous NSCLC with no contraindications to immunotherapy or bevacizumab and negative for EGFR, ALK, ROS1, or BRAF genetic alterations, regardless of PD-L1 expression levels, pembrolizumab/chemotherapy is "preferred" and the bevacizumab/carboplatin/paclitaxel regimen is now "other recommended options."