NCCN Guidelines® Insights: Non–Small Cell Lung Cancer, Version 2.2023

Ettinger, David S.; Wood, Douglas E.; Aisner, Dara L.; Akerley, Wallace; Bauman, Jessica R.; Bharat, Ankit; Bruno, Débora S.; Chang, Joe Y.; Chirieac, Lucian R.; DeCamp, Malcolm M.; Dowell, Jonathan E.; Durm, Greg Andrew; Gettinger, Scott; Grotz, Travis E.; Gubens, Matthew A.; Hegde, Aparna; Lackner, Rudy P.; Lanuti, Michael; Lin, Jules; Loo, Billy W.; Lovly, Christine M.; Maldonado, Fabien; Massarelli, Erminia; Morgensztern, Daniel; Ng, Thomas; Patel, Sandip Pravin; Patil, Tejas; Polanco, Patricio M.; Riely, Gregory J.; Riess, Jonathan W.; Schild, Steven E.; Shapiro, Theresa A.; Singh, Aditi; Stevenson, James P.; Tam, Alda L.; Tanvetyanon, Tawee; Yanagawa, Jane; Yang, Stephen C.; Yau, Edwin; Gregory, Kristina M; Hughes, Miranda

doi:10.6004/jnccn.2023.0020

Cited by 252 publications

(108 citation statements)

References 29 publications

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Section: Potential Impactmentioning

confidence: 99%

“…MRI or CT with contrast are normally recommended for evaluating brain metastases [31]. For example, in nonsmall cell lung cancer patients, National Comprehensive Cancer Network recommended MRI brain for evaluation for clinical stage II disease or above [31]. As delays in detecting asymptomatic brain metastases may compromise disease control and increase mortality, some have expressed concerns that the brain may be under-imaged [32].…”

Section: Potential Impactmentioning

confidence: 99%

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The diagnostic performance of 18fluorine-fluorodeoxyglucose PET for brain metastases: a systematic review and meta-analysis

Chan

Lau

et al. 2023

Nuclear Medicine Communications

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Introduction Brain metastases may manifest as hypermetabolism or hypometabolism compared with normal brain activity on 18fluorine-fluorodeoxyglucose PET (18F-FDG PET). We aim to undertake a systematic review and meta-analysis to determine the diagnostic accuracy of FDG PET for detecting brain metastases from different extracranial primary cancers. Methods PubMed and EMBASE were searched systematically. Study selection and quality assessment were performed independently by two authors. Meta-analysis was performed using a bivariate random-effects model. Subgroup analysis and meta-regression would be performed if heterogeneity was found. Results A total of 2227 patients from 11 studies were included in the review and analysis. Using the bivariate random-effects model, summary patient-based sensitivity and specificity for all 11 studies were estimated to be 0.440 [95% confidence interval (CI)] 0.295–0.597) and 0.997 (95% CI, 0.977–1.000). In view of significant between-study heterogeneity (I 2 = 74.0% for sensitivity and I 2 = 67.3% for specificity), subgroup analyses were performed. Meta-regression showed significantly higher patient-based summary sensitivity for the three better-quality studies (a total of 1037 patients) with satisfactory index test (counting both hypermetabolism and hypometabolism as positive index test) and satisfactory reference standards (other imaging and clinical follow-up) compared with other included studies [0.735 (95% CI, 0.601–0.836) vs 0.304 (95% CI, 0.223–0.400), P value = 0.000]. Conclusion Our systematic review and meta-analysis showed that FDG PET has overall limited sensitivity and excellent specificity in the detection of brain metastases from extracranial primary cancers. Importantly, subgroup analyses showed that the sensitivity can be significantly improved by raising awareness of asymmetrical hypometabolism. Further studies are warranted to assess the benefits of including the brain in FDG PET studies for all or certain groups of oncological patients.

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Section: Potential Impactmentioning

confidence: 99%

Section: Potential Impactmentioning

confidence: 99%

The diagnostic performance of 18fluorine-fluorodeoxyglucose PET for brain metastases: a systematic review and meta-analysis

Chan

Lau

et al. 2023

Nuclear Medicine Communications

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“…In 2022, the Food and Drug Administration (FDA) approved neoadjuvant nivolumab with platinum-doublet chemotherapy for patients with resectable NSCLC based on results of the Phase III CheckMate 816 trial . This approval led to a recommendation by the National Comprehensive Cancer Network for neoadjuvant nivolumab with platinum-doublet chemotherapy in patients with stage IB to IIIA or IIIB (only T3, N2) NSCLC . In 2023, the FDA approved neoadjuvant pembrolizumab in combination with platinum-containing chemotherapy for resectable NSCLC followed by single-agent pembrolizumab in the adjuvant setting across all programmed cell death 1 ligand 1 (PD-L1) strata after overall survival (OS) results were produced from KEYNOTE-671 .…”

Section: Introductionmentioning

confidence: 99%

Neoadjuvant Chemoimmunotherapy for NSCLC

Sorin,

Prosty,

Ghaleb

et al. 2024

JAMA Oncol

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ImportanceTo date, no meta-analyses have comprehensively assessed the association of neoadjuvant chemoimmunotherapy with clinical outcomes in non–small cell lung cancer (NSCLC) in randomized and nonrandomized settings. In addition, there exists controversy concerning the efficacy of neoadjuvant chemoimmunotherapy for patients with NSCLC with programmed cell death 1 ligand 1 (PD-L1) levels less than 1%.ObjectiveTo compare neoadjuvant chemoimmunotherapy with chemotherapy by adverse events and surgical, pathological, and efficacy outcomes using recently published randomized clinical trials and nonrandomized trials.Data SourcesMEDLINE and Embase were systematically searched from January 1, 2013, to October 25, 2023, for all clinical trials of neoadjuvant chemoimmunotherapy and chemotherapy that included at least 10 patients.Study SelectionObservational studies and trials reporting the use of neoadjuvant radiotherapy, including chemoradiotherapy, molecular targeted therapy, or immunotherapy monotherapy, were excluded.Main Outcomes and MeasuresSurgical, pathological, and efficacy end points and adverse events were pooled using a random-effects meta-analysis.ResultsAmong 43 eligible trials comprising 5431 patients (4020 males [74.0%]; median age range, 55-70 years), there were 8 randomized clinical trials with 3387 patients. For randomized clinical trials, pooled overall survival (hazard ratio, 0.65; 95% CI, 0.54-0.79; I2 = 0%), event-free survival (hazard ratio, 0.59; 95% CI, 0.52-0.67; I2 = 14.9%), major pathological response (risk ratio, 3.42; 95% CI, 2.83-4.15; I2 = 31.2%), and complete pathological response (risk ratio, 5.52; 95% CI, 4.25-7.15; I2 = 27.4%) favored neoadjuvant chemoimmunotherapy over neoadjuvant chemotherapy. For patients with baseline tumor PD-L1 levels less than 1%, there was a significant benefit in event-free survival for neoadjuvant chemoimmunotherapy compared with chemotherapy (hazard ratio, 0.74; 95% CI, 0.62-0.89; I2 = 0%).Conclusion and RelevanceThis study found that neoadjuvant chemoimmunotherapy was superior to neoadjuvant chemotherapy across surgical, pathological, and efficacy outcomes. These findings suggest that patients with resectable NSCLC with tumor PD-L1 levels less than 1% may have an event-free survival benefit with neoadjuvant chemoimmunotherapy.

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“…3 Nevertheless, the treatment strategy for advanced lung cancer remains contentious due to the complexity and heterogeneity of tumors. 4 Recent studies have suggested that neoadjuvant immunotherapy, either alone or in combination with chemotherapy, significantly improves the prognosis of patients with middle to advanced stage resectable lung cancer. [5][6][7] In cases of unresectable advanced lung cancer, the primary treatment strategies involve concurrent or sequential radiotherapy and immunochemotherapy.…”

Section: Introductionmentioning

confidence: 99%

Subsequent surgical treatment or maintenance immunotherapy in stage III lung cancer patients achieving a favorable response following neoadjuvant immunotherapy: A matched retrospective cohort study from the surgical perspective

Dai,

Chen,

Zhou

et al. 2024

Thoracic Cancer

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BackgroundCurrent treatment strategies for advanced non‐small cell lung cancer (NSCLC) are highly individualized and subject to ongoing debates. In the era of immunotherapy, surgery assumes a critical role. The aim of this study was to investigate if subsequent surgical intervention, following a favorable response to immunotherapy and chemotherapy, could yield a more favorable prognosis for patients with advanced stage III NSCLC compared to the continuation of immunotherapy and chemotherapy.MethodsWe included patients whose tumors exhibited a favorable response (including partial response [PR] and complete response [CR]) to immunotherapy and chemotherapy. These patients were categorized into two groups based on their subsequent treatment plans: surgical and nonsurgical (continuation of maintenance immunotherapy and chemotherapy). The efficacy and long‐term prognosis of these groups were compared after matching them in a 1:1 ratio using propensity scores.ResultsIn total, 186 patients (93 in each group) were included in this study after matching via propensity scores. The 1‐ and 3‐year overall survival (OS) and progression‐free survival (PFS) rates were 96.0%, 88.5%, and 93.1%, 80.7% in the surgical group, and 93.2%, 83.1%, and 57.7%, 50.4% in the nonsurgical group, respectively. Patients in the surgical group exhibited significantly superior PFS and OS compared to those in the nonsurgical group (p = 0.025 and p = 0.00086). Univariate and multivariate analyses confirmed ΔBMI, Δtumor size reduction, tumor response, earlier clinical stage (IIIb vs. IIIa), and surgery as independent protective factor for patient prognosis. We further selected 101 patients with CR (39 in the surgical group and 62 in the nonsurgical group) and found that patients in the surgical group were significantly better in both PFS and OS. Our subgroup analysis in postoperative patients demonstrated that different surgical strategies did not significantly affect the long‐term prognosis of patients (PFS and OS) but could impact their perioperative experience.ConclusionPatients with advanced stage III NSCLC, whose tumors achieved PR and CR after 2–4 cycles of immunotherapy combined with chemotherapy, experience a more promising prognosis with subsequent surgical intervention compared with the continued immunotherapy. Despite encountering formidable obstacles, such as protracted surgical procedures and associated trauma, we must rise to the challenge and unleash the power of surgery after immunotherapy in advanced NSCLC.

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NCCN Guidelines® Insights: Non–Small Cell Lung Cancer, Version 2.2023

Cited by 252 publications

References 29 publications

The diagnostic performance of 18fluorine-fluorodeoxyglucose PET for brain metastases: a systematic review and meta-analysis

The diagnostic performance of 18fluorine-fluorodeoxyglucose PET for brain metastases: a systematic review and meta-analysis

Neoadjuvant Chemoimmunotherapy for NSCLC

Subsequent surgical treatment or maintenance immunotherapy in stage III lung cancer patients achieving a favorable response following neoadjuvant immunotherapy: A matched retrospective cohort study from the surgical perspective

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