NCCN Guidelines Version 11.2024 Non-Small Cell Lung Cancer PDF

NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) Non-Small Cell Lung Cancer Version 11.2024 — October 15, 2024...

NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) Non-Small Cell Lung Cancer Version 11.2024 — October 15, 2024 NCCN.org NCCN recognizes the importance of clinical trials and encourages participation when applicable and available. Trials should be designed to maximize inclusiveness and broad representative enrollment. NCCN Guidelines for Patients® available at www.nccn.org/patients Continue Version 11.2024, 10/15/24 © 2024 National Comprehensive Cancer Network® (NCCN®), All rights reserved. NCCN Guidelines® and this illustration may not be reproduced in any form without the express written permission of NCCN. Printed by asifa andleeb on 12/17/2024 7:27:24 AM. For personal use only. Not approved for distribution. Copyright © 2024 National Comprehensive Cancer Network, Inc., All Rights Reserved. NCCN Guidelines Version 11.2024 NCCN Guidelines Index Table of Contents Non-Small Cell Lung Cancer Discussion *Gregory J. Riely, MD, PhD/Chair † Þ Travis E. Grotz, MD ¶ Sandip P. Patel, MD ‡ † Þ Memorial Sloan Kettering Cancer Center Mayo Clinic Comprehensive Cancer Center UC San Diego Moores Cancer Center Douglas E. Wood, MD/Vice Chair ¶ Matthew A. Gubens, MD, MS † Tejas Patil, MD † Fred Hutchinson Cancer Center UCSF Helen Diller Family University of Colorado Cancer Center Dara L. Aisner, MD, PhD ≠ Comprehensive Cancer Center Patricio M. Polanco, MD ¶ University of Colorado Cancer Center Aditya Juloori, MD § UT Southwestern Simmons Wallace Akerley, MD † The UChicago Medicine Comprehensive Cancer Comprehensive Cancer Center Huntsman Cancer Institute at the University of Utah Center *Jonathan Riess, MD ‡ *Jessica R. Bauman, MD ‡ † Rudy P. Lackner, MD ¶ UC Davis Comprehensive Cancer Center Fox Chase Cancer Center Fred & Pamela Buffett Cancer Center Theresa A. Shapiro, MD, PhD ¥ Þ Ankit Bharat, MD ¶ £ Michael Lanuti, MD ¶ The Sidney Kimmel Comprehensive Robert H. Lurie Comprehensive Cancer Mass General Cancer Center Cancer Center at Johns Hopkins Center of Northwestern University Jules Lin, MD ¶ Aditi P. Singh, MD † Joe Y. Chang, MD, PhD § University of Michigan Rogel Cancer Center Abramson Cancer Center at the The University of Texas *Billy W. Loo, Jr., MD, PhD § University of Pennsylvania MD Anderson Cancer Center Stanford Cancer Institute James Stevenson, MD † Lucian R. Chirieac, MD ≠ £ *Christine M. Lovly, MD, PhD † Case Comprehensive Cancer Center/ Dana-Farber/Brigham and Women’s Vanderbilt-Ingram Cancer Center University Hospitals Seidman Cancer Center Cancer Center and Cleveland Clinic Taussig Cancer Institute Fabien Maldonado, MD £ Malcolm DeCamp, MD ¶ Vanderbilt-Ingram Cancer Center Alda Tam, MD ф University of Wisconsin Carbone Cancer Center The University of Texas *Daniel Morgensztern, MD † MD Anderson Cancer Center Aakash P. Desai, MD Siteman Cancer Center at Barnes-Jewish Hospital O'Neal Comprehensive Cancer Center at UAB and Washington University School of Medicine Tawee Tanvetyanon, MD, MPH † Moffitt Cancer Center Thomas J. Dilling, MD, MS § *Trey C. Mullikin, MD § Moffitt Cancer Center Duke Cancer Institute Jane Yanagawa, MD ¶ UCLA Jonsson Comprehensive Cancer Center Jonathan Dowell, MD † Thomas Ng, MD ¶ UT Southwestern Simmons The University of Tennessee Stephen C. Yang, MD ¶ Comprehensive Cancer Center Health Science Center The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Gregory A. Durm, MD, MS † Dawn Owen, MD, PhD § Indiana University Melvin and Bren Simon Mayo Clinic Comprehensive Cancer Center Edwin Yau, MD, PhD † Comprehensive Cancer Center Roswell Park Comprehensive Cancer Center *Dwight H. Owen, MD, MSc † Scott Gettinger, MD † Þ The Ohio State University Comprehensive Yale Cancer Center/Smilow Cancer Hospital Cancer Center - James Cancer Hospital and Solove Research Institute ‡ Hematology/Hematology oncology ¶ Surgery/Surgical oncology Þ Internal medicine ф Diagnostic/Interventional NCCN Continue † Medical oncology ≠ Pathology radiology £ Pulmonary medicine Kristina Gregory, RN, MSN ¥ Patient advocacy * Discussion Section Writing Lisa Hang, PhD NCCN Guidelines Panel Disclosures § Radiation oncology/Radiotherapy Committee Version 11.2024, 10/15/24 © 2024 National Comprehensive Cancer Network (NCCN ), All rights reserved. NCCN Guidelines® and this illustration may not be reproduced in any form without the express written permission of NCCN. ® ® Printed by asifa andleeb on 12/17/2024 7:27:24 AM. For personal use only. Not approved for distribution. Copyright © 2024 National Comprehensive Cancer Network, Inc., All Rights Reserved. NCCN Guidelines Version 11.2024 NCCN Guidelines Index Table of Contents Non-Small Cell Lung Cancer Discussion NCCN Non-Small Cell Lung Cancer Panel Members Summary of Guidelines Updates Find an NCCN Member Institution: https://www.nccn.org/home/member- Lung Cancer Prevention and Screening (PREV-1) institutions. Clinical Presentation and Risk Assessment (DIAG-1) NCCN Categories of Evidence and Initial Evaluation and Clinical Stage (NSCL-1) Consensus: All recommendations Evaluation and Treatment: are category 2A unless otherwise Stage IA (T1abc, N0) (NSCL-2) indicated. Stage IB (peripheral T2a, N0), Stage I (central T1abc–T2a, N0), Stage II (T1abc–2ab, N1; T2b, N0), Stage IIB (T3, N0), and Stage IIIA (T3, N1) (NSCL-3) See NCCN Categories of Evidence Stage IIB (T3 invasion, N0) and Stage IIIA (T4 extension, N0–1; T3, N1; T4, N0–1) (NSCL-5) and Consensus. Stage IIIA (T1–2, N2); Stage IIIB (T3, N2); Separate Pulmonary Nodule(s) (Stage IIB, IIIA, IV) (NSCL-8) Multiple Lung Cancers (N0–1) (NSCL-12) Stage IIIB (T1–2, N3); Stage IIIC (T3, N3) (NSCL-13) NCCN Categories of Preference: Stage IIIB (T4, N2); Stage IIIC (T4, N3); Stage IVA, M1a: Pleural or Pericardial Effusion (NSCL-14) All recommendations are considered Stage IVA, M1b (NSCL-15) appropriate. Surveillance After Completion of Definitive Therapy (NSCL-17) Therapy for Recurrence and Metastasis (NSCL-18) See NCCN Categories of Systemic Therapy for Advanced or Metastatic Disease (NSCL-19) Preference. Principles of Pathologic Review (NSCL-A) Principles of Surgical Therapy (NSCL-B) Principles of Radiation Therapy (NSCL-C) Principles of Image-Guided Thermal Ablation Therapy (NSCL-D) Perioperative Systemic Therapy (NSCL-E) Concurrent Chemoradiation Regimens (NSCL-F) Cancer Survivorship Care (NSCL-G) Principles of Molecular and Biomarker Analysis (NSCL-H) Emerging Biomarkers to Identify Novel Therapies for Patients with Metastatic NSCLC (NSCL-I) Staging (ST-1) Molecular and Biomarker-Directed Therapy for Advanced or Metastatic Disease (NSCL-J) Systemic Therapy for Advanced or Metastatic Disease (NSCL-K) Abbreviations (ABBR-1) The NCCN Guidelines® are a statement of evidence and consensus of the authors regarding their views of currently accepted approaches to treatment. Any clinician seeking to apply or consult the NCCN Guidelines is expected to use independent medical judgment in the context of individual clinical circumstances to determine any patient’s care or treatment. The National Comprehensive Cancer Network® (NCCN®) makes no representations or warranties of any kind regarding their content, use or application and disclaims any responsibility for their application or use in any way. The NCCN Guidelines are copyrighted by National Comprehensive Cancer Network®. All rights reserved. The NCCN Guidelines and the illustrations herein may not be reproduced in any form without the express written permission of NCCN. ©2024. Version 11.2024, 10/15/24 © 2024 National Comprehensive Cancer Network® (NCCN®), All rights reserved. NCCN Guidelines® and this illustration may not be reproduced in any form without the express written permission of NCCN. Printed by asifa andleeb on 12/17/2024 7:27:24 AM. For personal use only. Not approved for distribution. Copyright © 2024 National Comprehensive Cancer Network, Inc., All Rights Reserved. NCCN Guidelines Version 11.2024 NCCN Guidelines Index Table of Contents Non-Small Cell Lung Cancer Discussion Terminologies in all NCCN Guidelines are being actively modified to advance the goals of equity, inclusion, and representation. Updates in Version 11.2024 of the NCCN Guidelines for Non-Small Cell Lung Cancer from Version 10.2024 include: NSCL-E 2 of 6 Neoadjuvant Systemic Therapy in Patients Who Are Candidates for Immune Checkpoint Inhibitors Bullet 1 modified: Nivolumab 360 mg and platinum-based doublet chemotherapy every 3 weeks for up to 34 cycles with the option of continuing single-agent nivolumab as adjuvant treatment after surgery (for patients with no known EGFR mutations or ALK rearrangements) (category 1); Systemic Therapy Following Surgical Resection NSCL-E 5 of 6 Systemic Therapy Following Surgical Resection Bullet 5 modified: Pembrolizumab 200 mg every 3 weeks or 400 mg every 6 weeks for up to 1 year ◊ Sub-bullet 1 modified: For up to a year for patients with completely resected stage IIB–IIIA, stage IIIB (T3, N2), or high-risk stage IIA NSCLC and negative for EGFR exon 19 deletion or exon 21 L858R mutations or ALK rearrangements who received previous adjuvant chemotherapy and with no contraindications to immune checkpoint inhibitors. The benefit for patients with PD-L1