National Comprehensive Cancer Network

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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

To access the NCCN Biomarkers Compendium®, please visit

To view the NCCN Guidelines for Patients®, please visit

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