NCCN Guidelines for Patients® Version Updates: Non-Small Cell Lung Cancer

Following are the major updates that were included in the NCCN Guidelines for Patients®: Non-Small Cell Lung Cancer, Version 1.2014:

  • Part 5.4 Molecular tests, pp. 38–39
    • Changed "some squamous” to "consider for squamous” in the table. Below the table, the text now reads, "Therefore, molecular testing of widespread squamous cell carcinoma should be considered, especially for people who never smoked and for mixed histology.”
    • Added "There are other gene changes associated with non-small cell lung cancer. Molecular testing for these gene changes should be done along with EGFR and ALK. However, clinical trials of treatments for these gene changes in people with lung cancer have not been completed or started. Other gene changes linked with lung cancer include:
      • BRAF mutations,
      • HER2 mutations,
      • MET amplifications,
      • ROS1 gene fusions, and
      • RET gene fusions."
  • Part 7.1 Stage I treatments, p. 56
    • In the chart, for unable or refused surgery, primary treatment was changed to "Radiation therapy including SABR.” Adjuvant treatment was added, "Consider chemotherapy for high-risk stage IB.”
  • Part 7.2 Stage II treatment, p. 58
    • o In the chart, margin status was changed for stage IIA with N1 disease and for stage IIB to "No cancer in margins,” "Cancer not seen with naked eye,” or "Cancer seen with naked eye.” Adjuvant treatment for when cancer isn’t seen with naked eye is either "Surgery + chemotherapy” or "Concurrent or sequential chemoradiation.” Adjuvant treatment for when cancer is seen with naked eye is either "Surgery + chemotherapy” or "Concurrent chemoradiation.”
  • Part 7.2 Stage II treatments, p. 60
    • In the chart, for stage II with N0 disease, primary treatment was changed to "Consider chemotherapy for high-risk stage II.” Followed by "Radiation therapy including SABR.”
    • In the chart, for stage II with N1 disease, primary treatment was changed to "Chemoradiation.”
  • Part 7.2 Stage II treatments, p. 61
    • In the chart, when there’s growth into the chest wall or bronchi, margin status was changed to "No cancer in margins,” "Cancer not seen with naked eye,” or "Cancer seen with naked eye” for when no adjuvant treatment is used before surgery. Adjuvant treatment for when cancer isn’t seen with naked eye is either "Surgery + chemotherapy” or "Concurrent or sequential chemoradiation.” Adjuvant treatment for when cancer is seen with naked eye is either "Surgery + chemotherapy” or "Concurrent chemoradiation.”
    • In the chart, when there’s growth into the chest wall or bronchi, changes were made for adjuvant treatment when neoadjuvant treatment is used before surgery. For when no cancer is in the margins, "Observe” is now recommended. For when cancer is in the margins, "Surgery” is now recommended.
  • Part 7.3 Stage III treatments, p. 63
    • In the chart, margin status was changed to "No cancer in margins,” "Cancer not seen with naked eye,” or "Cancer seen with naked eye” for tumors treated with surgery. Adjuvant treatment for when cancer isn’t seen with naked eye is "Concurrent or sequential chemoradiation.” Adjuvant treatment for when cancer is seen with naked eye is "Concurrent chemoradiation.”
  • Part 7.3 Stage III treatments, p. 64
    • In the chart, margin status was changed to "No cancer in margins,” "Cancer not seen with naked eye,” or "Cancer seen with naked eye” for tumors treated with surgery. Adjuvant treatment for when cancer isn’t seen with naked eye is "Concurrent or sequential chemoradiation.” Adjuvant treatment for when cancer is seen with naked eye is "Concurrent chemoradiation.”
  • Part 7.5 Stage IV treatments, p. 74
    • Added "afatinib" as a first-line treatment option for people with overactive EGFR mutation.
  • Part 7.5 Stage IV treatments, p. 75
    • Removed "stay on all drugs" for all histologic subtypes.
  • Part 7.5 Stage IV treatments, p. 76
    • Added "Gemcitabine" as an option for treatment after first line for both non-squamous and squamous types with performance scores of 0, 1, or 2.