National Comprehensive Cancer Network

About NCCN

NCCN GUIDELINES AND NCCN COMPENDIUM UPDATED

NCCN Flash Update sent June 20, 2014

NCCN has published updates to the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) and NCN Drugs & Biologics Compendium (NCCN Compendium®) for Small Cell Lung Cancer. These NCCN Guidelines are currently available as Version 1.2015.

  • Subsequent Therapy/Palliative Therapy (SCL-6)
    • PS 0-2, after two cycles beyond best response or progression of disease or development of unacceptable toxicity: "Consider subsequent chemotherapy if still PS 0-2"
  • Principles of Chemotherapy (SCL-C 1 of 2)
    • Chemotherapy as primary or adjuvant therapy, extensive stage, sub-bullet 6: "every 21 days" removed.
    • Subsequent chemotherapy, relapse <2–3 mo: "PO or IV" added to topotecan.
  • Principles of Radiation Therapy
    • SCL-C 1 of 3
      • Limited stage: Last bullet, last sentence changed from "A concomitant boost approach of 61.2 Gy in 5 weeks has shown promising local control; this boost approach is currently being compared to 70 Gy in 7 weeks and to the standard arm of 45 Gy (BID) in 3 weeks in the randomized trial CALGB 30610/RTOG 0538"  to "The current randomized trial, CALGB 30610/RTOG 0538, is comparing the standard arm of 45 Gy (BID) in 3 weeks to 70 Gy in 7 weeks; accrual to an experimental concomitant boost arm has closed."
    • SCL-C 2 of 3
      • Prophylactic Cranial Irradiation: Bullet 2 modified: "Recommended doses for PCI to the whole brain are include 25 Gy in 10 daily fractions, 30 Gy in 10 to 15 daily fractions, or 24 Gy in 8 daily fractions. A shorter course (eg, 20 Gy in 5 fractions) may be appropriate in selected patients with extensive-stage disease. In a large randomized trial (PCI 99-01), patients receiving a dose of 36 Gy had higher mortality and higher chronic neurotoxicity compared to patients treated with 25 Gy."
      • Brain Metastases: Bullet 2 modified with the addition of the fractionation schedule of 10 daily fractions.
  • Lung Neuroendocrine Tumors (LNT-1)
    • Footnote "c" is new to the page: "Stage-specific management of LCNEC follows the NSCLC algorithm. However, available data suggest that chemotherapy regimens commonly used for SCLC (see SCL-C) may represent the most reasonable option when systemic therapy is indicated." [References added.]
    • A new category added for "High-grade neuroendocrine carcinoma (small cell carcinoma)" with a link to the treatment for the NCCN Guidelines for Small Cell Lung Cancer.
  • Lung Neuroendocrine Tumors (LNT-2)
    • Primary Treatment: Footnote "f" modified: "There is no substantial evidence for a commonly used regimen preferred regimen." The following added: "± capecitabine" after temozolomide." [Reference added.]
    • New algorithm provided for Stage IIIA.
  • Staging (ST-1)
    • Table 1: The definitions modified as noted below:
      1) Limited-stage: AJCC (7th edition) stage I-III (T any, N any, M0) that can be safely treated with definitive radiation doses. Excludes T3-4 due to multiple lung nodules that are too extensive or have tumor/nodal volume that is too large to be encompassed in a tolerable radiation plan.
      2) Extensive-stage: AJCC (7th edition) stage IV (T any, N any, M 1a/b), or T3-4 due to multiple lung nodules that are too extensive or have tumor/nodal volume that is too large to be encompassed in a tolerable radiation plan.

For the complete updated versions of the NCCN Guidelines, NCCN Compendium®, and the NCCN Chemotherapy Order Templates (NCCN Templates®), please visit NCCN.org.

To access the NCCN Biomarkers Compendium®, please visit NCCN.org/biomarkers.

To view the NCCN Guidelines for Patients®, please visit NCCN.org/patients.

Free NCCN Guidelines apps iPhone, iPad, and Android devices are now available! Visit NCCN.org/apps