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NCCN Flash Update: NCCN Guidelines®, NCCN Compendium®, NCCN Radiation Therapy Compendium™, & NCCN Imaging AUC™ for Small Cell Lung Cancer

NCCN has published updates to the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®), the NCCN Drugs & Biologics Compendium (NCCN Compendium®), the NCCN Radiation Therapy Compendium™, and the NCCN Imaging Appropriate Use Criteria (NCCN Imaging AUC™) for Small Cell Lung Cancer. These NCCN Guidelines® are currently available as Version 1.2018.          

  • Additional Workup (SCL-2)
    • Bullet 2 was modified: “Pulmonary function tests (PFTs) during evaluation for surgery (if clinically indicated)
    • Bullet 3 was modified: “Bone imaging (radiographs or MRI) as appropriate if PET/CT equivocal (Consider biopsy if bone imaging is equivocal)
       
  • Adjuvant Treatment (SCL-3)
  • Clinical stage N+ separated into N1 and N2
  • N1 adjuvant treatment option added: “Systemic therapy ± mediastinal RT (sequential or concurrent)”
  • N2 adjuvant treatment option added: “Systemic therapy + mediastinal RT (sequential or concurrent)”
  • Footnote “o” was modified: “For patients receiving adjuvant therapy, response assessment should occur only after completion of initial adjuvant therapy (SCL-5); do not repeat scans to assess response during adjuvant treatment.”
     
  • Initial Treatment of Asymptomatic Brain Metastases (SCL-4)
  • Statement was modified: “May administer systemic therapy first, with whole-brain RT after completion of systemic therapy”
     
  • Adjuvant Treatment; Extensive disease: “PCI ± thoracic RT” revised to “Consider PCI ± thoracic RT.” (SCL-5)
     
  • Complete response or partial response (SCL-5)
  • Limited stage
  • A statement was revised: “After completion of initial recovery from primary therapy:”
  • Bullet 1 was revised: “Oncology follow-up visits every 3–4 mo during y 1–2, every 6 mo during y 3–5, then annually”
  • Bullet 2 was added: “If PCI not given, then MRI (preferred) or CT brain with contrast every 3–4 mo during y 1–2”
  • Extensive stage
  • A statement was added: “After completion of initial or subsequent therapy”
  • Bullet 1 was added: “Oncology follow-up visits every 2 mo during y 1, every 3–4 mo during y 2–3, then every 6 mo during years 4–5, then annually”
  • Bullet 2 was added: “If PCI not given, then MRI (preferred) or CT brain with contrast every 3–4 mo during y 1–2”
  • Footnote “u” for thoracic RT was revised: “Sequential radiotherapy to thorax in selected patients, especially with residual thoracic disease and low-bulk extrathoracic metastatic disease and complete response that has responded to systemic therapy.”
  • Stable disease
  • Limited stage and Extensive stage
  • Statement was revised: “After completion of initial recovery from primary therapy:”
  • Bullet 1 was revised: “Oncology follow-up visits every 3-4 mo during y 1–2, every 6 mo during y 3–5, then annually”
  • Statement was added: “After completion of initial or subsequent therapy”
  • Bullet 1 was added: “Oncology follow-up visits every 2 mo during y 1, every 3–4 mo during y 2–3, then every 6 mo during years 4–5, then annually”
     
  • Signs and Symptoms of Small Cell Lung Cancer (SCL-A) is a new section.
     
  • Principles of Pathologic Review (SCL-B) is a new section.
     
  • (SCL-E) Principles of Systemic Therapy (1 of 3)
  • Extensive stage (maximum of 4–6 cycles)
  • Bullet 7 was revised: “Cisplatin 30 mg/m2 days 1, 8 and irinotecan 65 mg/m2 days 1, 8”
  • Footnote “†” was added: “If not used as original regimen, may be used as therapy for primary progressive disease.”
  • Subsequent systemic therapy
  • Footnote “‡” was added: “Subsequent systemic therapy refers to second-line and beyond therapy.”
  • Relapse ≤6 mo, PS 0-2: nivolumab ± ipilimumab
  • Reference “22” was added: “Hellmann MD, Ott PA, Zugazagoitia J, et al. First report of a randomized expansion cohort from CheckMate 032 [abstract]. J Clin Oncol 2017;35: Abstract 8503.”
     
  • (SCL-E) Principles of Systemic Therapy (2 of 3)
  • For limited-stage, sub-bullet was revised: “For patients receiving initial adjuvant therapy, response assessment should occur only after completion of initial adjuvant therapy; do not repeat scans to assess response during adjuvant treatment.”
     
  • Principles of Radiation Therapy (SCL-F) pages were extensively revised.
     
  • The AJCC TNM Staging System for Small Cell Lung Cancer was updated to the 8th edition.
     (ST-1)

For the complete updated versions of the NCCN Guidelines, NCCN Guidelines with NCCN Evidence Blocks™, the NCCN Compendium®, the NCCN Biomarkers Compendium®, the NCCN Chemotherapy Order Templates (NCCN Templates®), the NCCN Radiation Therapy Compendium™, and NCCN Imaging AUC™, please visit NCCN.org.

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

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