National Comprehensive Cancer Network

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NCCN Flash Update: NCCN Guidelines Updated

Flash Update Sent October 7, 2011

NCCN has published updates to the NCCN Guidelines and the NCCN Drugs & Biologics Compendium (NCCN Compendium®) for Non-Small Cell Lung Cancer. These NCCN Guidelines are currently available as Version 2.2012.

  • Second-line treatment recommendation modified: Platinum doublet ± bevacizumab, if erlotinib or crizotinib given as first-line treatment and nonsquamous histologic subtype.
  • For squamous cell carcinoma: testing recommendation modified: EGFR mutation and ALK testing are not routinely recommended.
  • The Principles of Pathologic Review section was updated.
  • The Discussion section was updated to reflect the changes in the algorithm.


Flash Update Sent September 9, 2011

NCCN has published updates to the NCCN Guidelines and the NCCN Compendium® for Non-Small Cell Lung Cancer. These NCCN Guidelines are currently available as Version 1.2012.

  • Pretreatment evaluation: “and/or EBUS/EUS” added to mediastinoscopy. EBUS/EUS changed from a category 2B to a 2A for stage IB (peripheral T2a, N0), stage I (central T1ab-T2a, N0), stage II (T1ab-2ab, N1; T2b, N0), stage IIB (T3, N0).
  • Brain metastases: “category 1 for one metastasis” added to SRS + WBRT.
  • Surveillance: Chest CT interval changed from 4-6 months to 6-12 months and the use of contrast is now optional.
  • Recurrent or metastatic disease; first-line therapy:
      • ALK testing added as a category 2A recommendation for adenocarcinoma, large cell, or NSCLC NOS.

      • Crizotinib added as a category 2A recommendation for patients that are ALK positive.

      • EGFR mutation positive discovered prior to first-line therapy: erlotinib recommendation changed from a category 2A to a category 1 recommendation.

      • EGFR mutation positive discovered during chemotherapy: erlotinib recommendation changed from a category 2A to a 2B when added to current chemotherapy.

    • EGFR mutation or ALK negative or unknown: cetuximab/vinorelbine/cisplatin removed as a treatment option for patient with a performance status of 2.
  • Recurrent or metastatic disease; maintenance therapy:
      • Pemetrexed continuation maintenance changed from a category 2B to a 2A for patients with adenocarcinoma, large cell or NSCLC NOS.

      • Gemcitabine continuation maintenance added as a category 2A recommendation.

      • Erlotinib switch maintenance changed from a category 2B to a 2A recommendation.

    • Docetaxel switch maintenance deleted as an option for adenocarcinoma, large cell, or NSCLC NOS and changed from a category 3 to 2A for squamous cell carcinoma.
  • Recurrent or metastatic disease; second-line therapy:
    • Platinum doublet chemotherapy ± bevacizumab changed from a category 2B to a 2A recommendation.
  • Recurrent or metastatic disease; third-line therapy:
    • Erlotinib deleted for patients with a performance status of 3-4.
  • Principles of Pathologic Review and Principle of Radiation Therapy extensively revised.
  • A footnote was added to the Chemotherapy Regimens for Adjuvant Therapy and Chemotherapy Regimens used with Radiation Therapy to identify regimens that can be used for neoadjuvant chemotherapy or neoadjuvant chemoradiotherapy.


For the complete updated version of these and all NCCN Guidelines, visit NCCN.org.