nav emailalert searchbtn searchbox tablepage yinyongbenwen piczone journalimg journalInfo journalinfonormal searchdiv qikanlogo popupnotification paper paperNew
2022, 03, 197-204
2022年第3版《NCCN非小细胞肺癌临床实践指南》更新解读
基金项目(Foundation): 浙江省自然科学基金项目(LY21H310002);浙江省卫生健康科技计划项目(2022KY933)
邮箱(Email):
DOI: 10.13267/j.cnki.syzlzz.2022.033
摘要:

美国国家综合癌症网络(National Comprehensive Cancer Network,NCCN)是由32家世界知名癌症中心组成的非营利性联盟组织,旨于提供更优质、高效和合理的癌症患者管理模式。NCCN每年持续更新临床实践指南,指南以临床研究数据为依据,确保肿瘤领域专家和患者均能获取最新的癌症预防、筛选和治疗方法,从而达到最佳疗效。NCCN指南不仅是美国肿瘤领域临床决策的标准,而且是全球肿瘤临床实践最广泛的指南。2022年《NCCN非小细胞肺癌临床实践指南》目前更新至第3版,较2021年第7版指南主要在临床评估、分子标志物检测、围手术期治疗、放疗、晚期非小细胞肺癌靶向治疗和免疫治疗等方面进行更新。本文就新版指南更新内容进行逐一解读。

Abstract:

The National Comprehensive Cancer Network (NCCN) is a non-profit alliance composed of 32 world-renowned cancer centers, aiming to provide a better, more efficient and more appropriate management model for cancer patients. NCCN continuously updates clinical practice guidelines every year. The guidelines are based on clinical research evidence to ensure that oncology experts and cancer patients have access to the latest cancer prevention, screening and treatment methods to achieve the best treatment effect. The NCCN guidelines are not only the standard for clinical decision-making in the oncology field in the United States, but also the most extensive guidelines for clinical practice in oncology worldwide. The NCCN guidelines for the clinical diagnosis and treatment of non-small-cell lung cancer (NSCLC) is currently updated to version 3. 2022. Compared with version 7, 2021, the updated content of this version mainly focused on evaluation, molecular testing, perioperative treatment, and radiotherapy for NSCLC and targeted therapy and immunotherapy for advanced NSCLC. This article will interpret the updated content of the new version of the guidelines.

参考文献

[1] Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020:GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2021, 71(3):209-249.

[2] Zheng RS, Zhang SW, Zeng HM, et al. Cancer incidence and mortality in China, 2016[J]. J Natl Cancer Cent, 2022, 2(1):1-9.

[3] Howlader N, Noone AM, Krapcho M, et al. SEER Cancer Statistics Review, 1975-2018[EB/OL]. (2021-04)[2022-04-28]. https://seer.cancer.gov/csr/1975_2018/.

[4] NCCN non-small cell lung cancer panel members. NCCN guidelines for non-small cell lung cancer (version 3,2022).2022, 1-285[EB/OL]. (2022-03-16)[2022-05-10]. https://www.nccn.org/professionals/physician_gls/pdf/nscl.pdf

[5] NCCN non-small cell lung cancer panel members. NCCN guidelines for non-small cell lung cancer (version 7,2021).2021, 1-259[EB/OL]. (2021-10-29)[2022-05-10]. https://www.nccn.org/professionals/physician_gls/pdf/nscl.pdf

[6] Chen AC, Pastis NJ Jr, Mahajan AK, et al. Robotic bronchoscopy for peripheral pulmonary lesions:a multicenter pilot and feasibility study (BENEFIT)[J]. Chest, 2021, 159(2):845-852.

[7] Kalchiem-Dekel O, Connolly JG, Lin IH, et al. Shape-sensing robotic-assisted bronchoscopy in the diagnosis of pulmonary parenchymal lesions[J]. Chest, 2022, 161(2):572-582.

[8] Maleki Z, Nadella A, Nadella M, et al. INSM1, a novel biomarker for detection of neuroendocrine neoplasms:cytopathologists' view[J]. Diagnostics (Basel), 2021, 11(12):2172.

[9] Rolfo C, Mack PC, Scagliotti GV, et al. Liquid biopsy for advanced non-small cell lung cancer (NSCLC):a statement paper from the IASLC[J]. J Thorac Oncol, 2018, 13(9):1248-1268.

[10] Khodakov D, Wang CY, Zhang DY. Diagnostics based on nucleic acid sequence variant profiling:PCR, hybridization, and NGS approaches[J]. Adv Drug Deliv Rev, 2016, 105(Pt A):3-19.

[11] Yu HA, Arcila ME, Rekhtman N, et al. Analysis of tumor specimens at the time of acquired resistance to EGFR-TKI therapy in 155 patients with EGFR-mutant lung cancers[J]. Clin Cancer Res, 2013, 19(8):2240-2247.

[12] Riely GJ, Yu HA. EGFR:the paradigm of an oncogene-driven lung cancer[J]. Clin Cancer Res, 2015, 21(10):2221-2226.

[13] Berry DK, Wang X, Michalski ST, et al. Clinical cohort analysis of germline EGFR T790M demonstrates penetrance across ethnicities and races, sexes, and ages[J]. JCO Precis Oncol, 2020, 4:PO.19.00297.

[14] Schoenfeld AJ, Chan JM, Kubota D, et al. Tumor analyses reveal squamous transformation and off-target alterations as early resistance mechanisms to first-line osimertinib in EGFR-mutant lung cancer[J]. Clin Cancer Res, 2020, 26(11):2654-2663.

[15] Marcoux N, Gettinger SN, O'Kane G, et al. EGFR-mutant adenocarcinomas that transform to small-cell lung cancer and other neuroendocrine carcinomas:clinical outcomes[J]. J Clin Oncol, 2019, 37(4):278-285.

[16] Zhou CC, Ramalingam SS, Kim TM, et al. Treatment outcomes and safety of mobocertinib in platinum-pretreated patients with EGFR exon 20 insertion-positive metastatic non-small cell lung cancer:a phase 1/2 open-label nonrandomized clinical trial[J]. JAMA Oncol, 2021, 7(12):e214761.

[17] Lindeman NI, Cagle PT, Aisner DL, et al. Updated molecular testing guideline for the selection of lung cancer patients for treatment with targeted tyrosine kinase inhibitors:guideline from the College of American Pathologists, the International Association for the Study of Lung Cancer, and the Association for Molecular Pathology[J]. J Mol Diagn, 2018, 20(2):129-159.

[18] Mitchell RL, Kosche C, Burgess K, et al. Misdiagnosis of Li-fraumeni syndrome in a patient with clonal hematopoiesis and a somatic TP53 mutation[J]. J Natl Compr Canc Netw, 2018, 16(5):461-466.

[19] Goldstraw P, Crowley J, Chansky K, et al. The IASLC Lung Cancer Staging Project:proposals for the revision of the TNM stage groupings in the forthcoming (seventh) edition of the TNM Classification of malignant tumours[J]. J Thorac Oncol, 2007, 2(8):706-714.

[20] Travis WD, Asamura H, Bankier AA, et al. The IASLC Lung Cancer Staging Project:Proposals for coding T categories for subsolid nodules and assessment of tumor size in part-solid tumors in the forthcoming eighth edition of the TNM classification of lung cancer[J]. J Thorac Oncol, 2016, 11(8):1204-1223.

[21] Forde PM, Spicer J, Lu S, et al. Abstract CT003:Nivolumab (NIVO) + platinum-doublet chemotherapy (chemo) vs chemo as neoadjuvant treatment (tx) for resectable (Ⅰ B-Ⅲ A) non-small cell lung cancer (NSCLC) in the phase 3 CheckMate 816 trial[J]. Cancer Res, 2021, 81(13_suppl):CT003.

[22] Wu YL, Tsuboi M, He J, et al. Osimertinib in resected EGFR-mutated non-small-cell lung cancer[J]. N Engl J Med, 2020, 383(18):1711-1723.

[23] le Pechoux C, Pourel N, Barlesi F, et al. Postoperative radiotherapy versus no postoperative radiotherapy in patients with completely resected non-small-cell lung cancer and proven mediastinal N2 involvement (Lung ART):an open-label, randomised, phase 3 trial[J]. Lancet Oncol, 2022, 23(1):104-114.

[24] Hui ZG, Men Y, Hu C, et al. Effect of postoperative radiotherapy for patients with pⅢA-N2 non-small cell lung cancer after complete resection and adjuvant chemotherapy:the phase 3 PORT-C randomized clinical trial[J]. JAMA Oncol, 2021, 7(8):1178-1185.

[25] Cho JH, Lim SH, An HJ, et al. Osimertinib for patients with non-small-cell lung cancer harboring uncommon EGFR mutations:a multicenter, open-label, phase Ⅱ trial (KCSG-LU15-09)[J]. J Clin Oncol, 2020, 38(5):488-495.

[26] Yang JC, Sequist LV, Geater SL, et al. Clinical activity of afatinib in patients with advanced non-small-cell lung cancer harbouring uncommon EGFR mutations:a combined post-hoc analysis of LUX-Lung 2, LUX-Lung 3, and LUX-Lung 6[J]. Lancet Oncol, 2015, 16(7):830-838.

[27] Schoenfeld AJ, Arbour KC, Rizvi H, et al. Severe immune-related adverse events are common with sequential PD-(L)1 blockade and osimertinib[J]. Ann Oncol, 2019, 30(5):839-844.

[28] Skoulidis F, Li BT, Dy GK, et al. Sotorasib for lung cancers with KRAS p.G12C mutation[J]. N Engl J Med, 2021, 384(25):2371-2381.

[29] Shaw AT, Solomon BJ, Besse B, et al. ALK resistance mutations and efficacy of lorlatinib in advanced anaplastic lymphoma kinase-positive non-small-cell lung cancer[J]. J Clin Oncol, 2019, 37(16):1370-1379.

[30] Planchard D, Smit EF, Groen HJM, et al. Dabrafenib plus trametinib in patients with previously untreated BRAFV600E-mutant metastatic non-small-cell lung cancer:an open-label, phase 2 trial[J]. Lancet Oncol, 2017, 18(10):1307-1316.

[31] Mazieres J, Cropet C, Montané L, et al. Vemurafenib in non-small-cell lung cancer patients with BRAFV600 and BRAFnonV600 mutations[J]. Ann Oncol, 2020, 31(2):289-294.

[32] Gainor JF, Curigliano G, Kim DW, et al. Pralsetinib for RET fusion-positive non-small-cell lung cancer (ARROW):a multi-cohort, open-label, phase 1/2 study[J]. Lancet Oncol, 2021, 22(7):959-969.

[33] Drilon A, Oxnard GR, Tan DSW, et al. Efficacy of selpercatinib in RET fusion-positive non-small-cell lung cancer[J]. N Engl J Med, 2020, 383(9):813-824.

[34] Drilon A, Rekhtman N, Arcila M, et al. Cabozantinib in patients with advanced RET-rearranged non-small-cell lung cancer:an open-label, single-centre, phase 2, single-arm trial[J]. Lancet Oncol, 2016, 17(12):1653-1660.

[35] Yoh K, Seto T, Satouchi M, et al. Final survival results for the LURET phase Ⅱ study of vandetanib in previously treated patients with RET-rearranged advanced non-small cell lung cancer[J]. Lung Cancer, 2021, 155:40-45.

[36] Le XN, Paz-Ares L, Meerbeeck J, et al. Tepotinib in patients (pts) with advanced non-small cell lung cancer (NSCLC) with MET amplification (MET amp)[J]. J Clin Oncol, 2021, 39(15_suppl):9021.

[37] Li BT, Smit EF, Goto Y, et al. Trastuzumab deruxtecan in HER2-mutant non-small-cell lung cancer[J]. N Engl J Med, 2022, 386(3):241-251.

[38] Timmerman R, Paulus R, Galvin J, et al. Stereotactic body radiation therapy for inoperable early stage lung cancer[J]. JAMA, 2010, 303(11):1070-1076.

[39] Palma D, Visser O, Lagerwaard FJ, et al. Impact of introducing stereotactic lung radiotherapy for elderly patients with stage Ⅰ non-small-cell lung cancer:a population-based time-trend analysis[J]. J Clin Oncol, 2010, 28(35):5153-5159.

[40] Chang JY, Senan S, Paul MA, et al. Stereotactic ablative radiotherapy versus lobectomy for operable stage Ⅰ nonsmall-cell lung cancer:a pooled analysis of two randomised trials[J]. Lancet Oncol, 2015, 16(6):630-637.

[41] Chang JY, Mehran RJ, Feng L, et al. Stereotactic ablative radiotherapy for operable stage Ⅰ non-small-cell lung cancer (revised STARS):long-term results of a single-arm, prospective trial with prespecified comparison to surgery[J]. Lancet Oncol, 2021, 22(10):1448-1457.

[42] Brooks ED, Sun B, Feng L, et al. Association of longterm outcomes and survival with multidisciplinary salvage treatment for local and regional recurrence after stereotactic ablative radiotherapy for early-stage lung cancer[J]. JAMA Netw Open, 2018, 1(4):e181390.

[43] Mauguen A, le Péchoux C, Saunders MI, et al. Hyperfractionated or accelerated radiotherapy in lung cancer:an individual patient data meta-analysis[J]. J Clin Oncol, 2012, 30(22):2788-2797.

[44] Kong FMS, Hu C, Ten Haken R, et al. NRG-RTOG 1106/ACRIN 6697:a phase ⅡR trial of standard versus adaptive (mid-treatment PET-based) chemoradiotherapy for stage Ⅲ NSCLC-Results and comparison to NRG-RTOG 0617(non-personalized RT dose escalation)[J]. J Clin Oncol, 2021, 39(15_suppl):8548.

[45] Theelen WSME, Chen DW, Verma V, et al. Pembrolizumab with or without radiotherapy for metastatic non-smallcell lung cancer:a pooled analysis of two randomised trials[J]. Lancet Respir Med, 2021, 9(5):467-475.

[46] Genshaft SJ, Suh RD, Abtin F, et al. Society of Interventional Radiology quality improvement standards on percutaneous ablation of non-small cell lung cancer and metastatic disease to the lungs[J]. J Vasc Interv Radiol, 2021, 32(8):1242.e1-1241.e12.

基本信息:

DOI:10.13267/j.cnki.syzlzz.2022.033

中图分类号:

引用信息:

[1]钱剑男1,杨邵瑜2,陈雪琴1,等.2022年第3版《NCCN非小细胞肺癌临床实践指南》更新解读[J],2022,37(03):197-204.DOI:10.13267/j.cnki.syzlzz.2022.033.

基金信息:

浙江省自然科学基金项目(LY21H310002);浙江省卫生健康科技计划项目(2022KY933)

检 索 高级检索

引用

GB/T 7714-2015 格式引文
MLA格式引文
APA格式引文