Non–Small Cell Lung Cancer, Version 3.2022, NCCN Clinical Practice Guidelines in Oncology

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.; D’Amico, Thomas A.; DeCamp, Malcolm M.; Dilling, Thomas J.; Dowell, Jonathan E.; 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, Tony; Otterson, Gregory A.; Pacheco, Jose M.; Patel, Sandip Pravin; 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.2022.0025

Cited by 893 publications

(701 citation statements)

References 236 publications

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“…Because of these interesting results, many trials are being conducted, among which SARON is one of the most ambitious [ 34 ]. Despite the growing number of studies and level of proof, few scientific societies propose recommendations for oligometastatic disease treatments: for NSCLC, the European Society of Medical Oncology (ESMO) still recommends protocol inclusion [ 35 ], and the National Cancer Comprehensive Network (NCCN) proposes radical treatments after careful tumor board assessment and in limited situations [ 36 ].…”

Section: Discussionmentioning

confidence: 99%

Loco-Regional Therapies in Oligometastatic Adrenocortical Carcinoma

Roux

Boilève

Faron

et al. 2022

Cancers

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Objective: The recommended first-line treatment for low-tumor-burden ACC (stage IVa ACC) not amenable to radical resection is mitotane in association with loco-regional treatments (LRs). The aim of this study was to determine the patient population that would benefit the most from LR. Materials and methods: This retrospective monocentric expert center chart review study was performed from 2008 to 2021 and included stage IVa patients (≤2 tumoral organs) treated with LR (either radiotherapy, surgery, or interventional radiology). The primary endpoint was disease control (DC). Correlations between DC, time to systemic chemotherapy (TTC), overall survival (OS), and tumor characteristics were analyzed using Kaplan–Meier survival analysis and Cox’s proportional hazards regression model for multivariate analysis. Results: Thirty-four women (57%) and 26 men with a median age of 48.1 years (IQR: 38.3–59.8) were included. One hundred and nine LRs were performed, with a median of 2 (IQR: 1–3) per patient. DC was achieved in 40 out of 60 patients (66.7%). Patients with DC had a significantly longer TTC (HR: 0.27, p < 0.001) and OS (HR: 0.22, p < 0.001). Patients with less than or equal to 5 metastases (HR: 6.15 (95% CI: 1.88–20.0), p = 0.002) or a maximum metastasis diameter below 3 cm had higher rates of DC (HR: 3.78 (95% CI: 1.09–13.14), p = 0.035). Conclusion: stage IVa ACC patients with ≤5 metastases or a maximum metastasis diameter below 3 cm had favorable responses to LR. We propose the name oligometastatic ACC for this subgroup of patients.

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Section: Discussionmentioning

confidence: 99%

Loco-Regional Therapies in Oligometastatic Adrenocortical Carcinoma

Roux

Boilève

Faron

et al. 2022

Cancers

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“…The existence of an ALK gene fusion in individuals with NSCLC predicts a therapeutic benefit from ALK inhibitor therapy [ 21 ]. Several ALK inhibitors have demonstrated significant benefits in the treatment of ALK- positive NSCLC patients in recent years.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Efficacy and Safety of Brigatinib in First-Line Treatments for Patients with Anaplastic Lymphoma Kinase-Positive Non-Small-Cell Lung Cancer: A Systematic Review and Indirect Treatment Comparison

Yang

Zhu²,

Zhang³

et al. 2022

JCM

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(1) Background: The relative efficacy and safety of brigatinib compared with other next-generation anaplastic lymphoma kinase (ALK) inhibitors remains unclear, as first-line head-to-head trials have not been conducted. (2) Methods: Electronic databases were systematically searched for eligible randomized controlled trials (RCT) from January 2010 to October 2021. Outcomes evaluated by indirect treatment comparison (ITC) included progression-free survival (PFS), overall survival (OS), objective response rate (ORR), and safety. (3) Results: Nine RCTs with 2484 patients assessing crizotinib, ceritinib, alectinib, brigatinib, ensartinib, and lorlatinib were included. In intent-to-treat (ITT) patients, brigatinib significantly prolonged blinded independent review committee-assessed PFS compared with crizotinib (HR: 0.48, 95% CI: 0.35 to 0.66) and ceritinib (HR: 0.38, 95% CI: 0.23, 0.60) and had a comparable PFS with other 2nd-generation ALK inhibitors. Subgroup analyses of patients with baseline brain metastases and Asian patients yielded results similar to the base case. Brigatinib significantly reduced the risk of death compared with crizotinib (HR: 0.50, 95% CI: 0.28, 0.87) after adjusting for treatment crossover in the crizotinib arm. No significant differences were observed in OS between brigatinib and other next-generation ALK inhibitors. Brigatinib had significantly superior effects in ORR and intracranial ORR compared to crizotinib. The incidence of grade ≥3 AEs was similar between brigatinib and other next-generation ALK inhibitors (except for alectinib), while brigatinib could significantly delay the time to worsening in the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30) global health status (GHS)/quality of life (QoL) vs. crizotinib (HR: 0.69, 95% CI: 0.49, 0.98). (4) Conclusions: Brigatinib had longer PFS compared to crizotinib and ceritinib and had comparable efficacy and safety profile with other 2nd-generation ALK inhibitors in first-line treatments for patients with ALK-positive non-small-cell lung cancer.

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“…However, to date it is still debated which radiotherapy (RT) regimens (e.g., dose per fraction) are optimal to stimulate synergies with ICB [ 7 ]. SBRT is an elegant treatment alternative for early stage lung cancer for medically inoperable patients or those who refuse surgery as well as for pulmonary metastases with excellent local control rates [ 14 , 15 , 16 , 17 , 18 , 19 , 20 ]. Furthermore, the combination of SBRT and ICB treatment has been investigated with beneficial clinical outcome [ 21 , 22 , 23 ] and a multitude of clinical trials is currently ongoing [ 8 , 24 , 25 ].…”

Section: Introductionmentioning

confidence: 99%

“…Furthermore, the combination of SBRT and ICB treatment has been investigated with beneficial clinical outcome [ 21 , 22 , 23 ] and a multitude of clinical trials is currently ongoing [ 8 , 24 , 25 ]. In current clinical guidelines, for early stage lung cancer, usually adjuvant chemotherapy is administered for stage II and III [ 26 ]; ICB can be considered for adjuvant treatment in stage IIA, IIB and IIIA, and is recommended for node-positive lung cancer after definitive chemo radiation [ 15 ]. Secondary lung cancer can also be treated with surgery, systemic agents and radiotherapy, usually depending on the primary tumor and the number and spread of metastases [ 27 ].…”

Section: Introductionmentioning

confidence: 99%

Pneumonitis after Stereotactic Thoracic Radioimmunotherapy with Checkpoint Inhibitors: Exploration of the Dose–Volume–Effect Correlation

Kraus

Bauer

Feuerecker

et al. 2022

Cancers

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Thoracic stereotactic body radiation therapy (SBRT) is extensively used in combination with immune checkpoint blockade (ICB). While current evidence suggests that the occurrence of pneumonitis as a side effect of both treatments is not enhanced for the combination, the dose–volume correlation remains unclear. We investigate dose–volume–effect correlations for pneumonitis after combined SBRT + ICB. We analyzed patient clinical characteristics and dosimetric data for 42 data sets for thoracic SBRT with ICB treatment (13) and without (29). Dose volumes were converted into 2 Gy equivalent doses (EQD2), allowing for dosimetric comparison of different fractionation regimes. Pneumonitis volumes were delineated and corresponding DVHs were analyzed. We noticed a shift towards lower doses for combined SBRT + ICB treatment, supported by a trend of smaller areas under the curve (AUC) for SBRT+ ICB (median AUC 1337.37 vs. 5799.10, p = 0.317). We present a DVH-based dose–volume–effect correlation method and observed large pneumonitis volumes, even with bilateral extent in the SBRT + ICB group. We conclude that further studies using this method with enhanced statistical power are needed to clarify whether adjustments of the radiation dose constraints are required to better estimate risks of pneumonitis after the combination of SBRT and ICB.

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Non–Small Cell Lung Cancer, Version 3.2022, NCCN Clinical Practice Guidelines in Oncology

Cited by 893 publications

References 236 publications

Loco-Regional Therapies in Oligometastatic Adrenocortical Carcinoma

Loco-Regional Therapies in Oligometastatic Adrenocortical Carcinoma

Comparison of Efficacy and Safety of Brigatinib in First-Line Treatments for Patients with Anaplastic Lymphoma Kinase-Positive Non-Small-Cell Lung Cancer: A Systematic Review and Indirect Treatment Comparison

Pneumonitis after Stereotactic Thoracic Radioimmunotherapy with Checkpoint Inhibitors: Exploration of the Dose–Volume–Effect Correlation

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