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NCCN Flash Update: NCCN Guidelines®, NCCN Compendium®, NCCN Templates®, & NCCN Radiation Therapy Compendium® for NSCLC

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

  • Nodule Management (DIAG-2 and DIAG-3)
    • The management of a solid and sub-solid nodule(s) on chest CT was modified based on the updated Fleischner criteria. MacMahon H, Naidich DP, Goo JM, et al. Guidelines for management of incidental pulmonary nodules detected on CT scans: From the Fleischner Society 2017. Radiology 2017;284:228-243.
  • Metastatic NSCLC – Sensitizing EGFR mutation positive
    • Subsequent Therapy (NSCL-19)
      • Multiple lesions; T790M-: The option for PD-L1 expression positive was removed.
      • Footnote qq was modified: "Consider osimertinib (regardless of T790M status) or pulse erlotinib for carcinomatosis meningitis progressive leptomeningeal disease."
      • Footnote tt is new to the page: "The data in the second-line setting suggest that immunotherapy is less effective, irrespective of PD-L1 expression, in tumors with an actionable mutation." (also applies to NSCL-20, NSCL-22, NSCL-23, and NSCL-24)
  • Metastatic NSCLC – ALK rearrangement positive
    • Subsequent Therapy (NSCL-22)
      • Systemic, Multiple lesions: The option for PD-L1 expression positive was removed.
      • Progression on crizotinib after treatment for Asymptomatic; Symptomatic Brain; Symptomatic, Systemic, Isolated lesion: The option for PDL1 expression positive was removed.
      • Footnote uu was added: "Beware of flare phenomenon in a subset of patients who discontinue ALK inhibitor. If disease flare occurs, restart ALK inhibitor."
      • Footnote yy is new to the page: "If considering WBRT, switch ALK inhibitor before using WBRT."
    • New page added to address progression on alectinib or ceritinib (NSCL-23)
  • Metastatic NSCLC – ROS1 rearrangement positive (NSCL-24)
    • First-line therapy: Ceritinib added as a treatment option. This is a category 2A recommendation.
    • First-line therapy: Crizotinib listed as a preferred treatment option.
    • Progression: The option for PD-L1 expression positive was removed.
  • Metastatic NSCLC – Adenocarcinoma, Large Cell, NSCLC NOS (NSCL-27)
    • Switch maintenance with pemetrexed changed from a category 2B to a category 2A.
  • Principles of Pathologic Review extensively revised (NSCL-A)
  • Principles of Radiation Therapy (NSCL-C 8 of 10)
    • Normal Tissue Dose-Volume Constraints for Conventionally Fractionated RT
      • Heart mean dose changed from ≤35 to ≤26 Gy.
  • Chemotherapy Regimens for Neoadjuvant and Adjuvant Therapy (NSCL-D)
    • Chemotherapy Regimens for Patients with Comorbidities or Patients Not Able to Tolerate Cisplatin; the following regimens were added:
      • Carboplatin AUC 5 day 1, gemcitabine 1000 mg/m2 days 1, 8, every 21 days for 4 cycles (category 2A)
      • Carboplatin AUC 5 day 1, pemetrexed 500 mg/m2 day 1 for nonsquamous every 21 days for 4 cycles (category 2A)
  • Chemotherapy Regimens Used with Radiation Therapy (NSCL-E)
    • The following were removed: Sequential Chemotherapy/RT Regimens (Adjuvant)
      • Cisplatin 100 mg/m2 on days 1 and 29; vinblastine 5 mg/m2/weekly on days 1, 8, 15, 22, and 29; followed by RT
      • Paclitaxel 200 mg/m2 over 3 hours on day 1; carboplatin AUC 6 over 60 minutes on day 1 every 3 weeks for 2 cycles followed by thoracic RT
    • Regimens to be used in sequential chemotherapy/RT are now linked to NSCL-D.
  • New section added to address the Principles of Molecular and Biomarker Analysis (NSCL-G)
  • Emerging Targeted Agents for Patients with Genetic Alterations (NSCL-H)
    • HER2 mutations
      • Ado-trastuzumab emtansine (category 2A) added
      • Single-agent therapy with trastuzumab or afatinib was removed
  • New section added providing references for Targeted Therapy for Advanced or Metastatic Disease (NSCL-I)
  • Staging was updated to reflect the changes in the AJCC Cancer Staging Manual, Eighth Edition (2016). (ST-1 and ST-2)
  • Table was added with a comparison of the descriptors in the eighth edition of the TNM classification of lung cancer compared with the seventh edition. Reference: Rami-Porta R, Asamura H, Travis WD, Rusch VW. Lung cancer - Major changes in the American Joint Committee on Cancer Eighth Edition Cancer Staging Manual. CA Cancer J Clin 2017;67:138-155. (ST-3)



The following NCCN Chemotherapy Order Templates (NCCN Templates®) have been deleted to reflect the NCCN Guidelines for Non-Small Cell Lung Cancer Version 1.2018:

  • NSC8 – CISplatin/VinBLAStine followed by Radiation
  • NSC9 – PACLItaxel/CARBOplatin followed by Radiation


The NCCN Radiation Therapy Compendium™ has been updated to reflect the changes to the following NCCN Guidelines:

  • T-Cell Lymphomas, Version 1.2018


For the complete updated versions of the NCCN Guidelines, NCCN Guidelines with NCCN Evidence Blocks™, the NCCN Compendium®, the NCCN Biomarkers Compendium®, the NCCN Templates®, the NCCN Radiation Therapy Compendium™, and the NCCN Imaging Appropriate Use Criteria (NCCN Imaging AUC™), please visit

To view the NCCN Guidelines for Patients®, please visit

Free NCCN Guidelines apps for iPhone, iPad, and Android smartphones & tablets are now available! Visit

About NCCN Flash Updates™ 
NCCN Flash Updates™ is a subscription service from NCCN that provides timely notification of updated and new information appearing in the NCCN Guidelines, the NCCN Compendium, and other NCCN Content. 

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