最新2024v1版NCCN非小细胞肺癌指南更新（完整版）.docx

最新2024v1版NCCN非小细胞肺癌指南更新（完整版）摘要近日，美国国家综合癌症网络（NCCN）发布了2024年首版非小细胞肺癌（NSCLC）临床实践指南。作为肿瘤诊疗领域最受关注的权威指南之一，NCCN指南的更新往往也反映着NSCLC治疗的关键动向和趋势。本次更新主要聚焦于EGFR、ROS1多靶点一线及耐药后治疗的6大治疗新理念，CCMTV小编特此整理。NationalComprehensiveNCCNCancerNetwork®NCCNClinicalPracticeGuidelinesinOncology(NCCNGuidelines)Non-SmallCellLungCancerVersion1.2024December21.2023NCCN.orgNCCNGuidelinesforPatientseavailableatwww.nccn.org/patientsContinue（HEGFR突变一线治疗：奥希替尼联合化疗对于EGFRExon19Del/Exon21L858R突变的晚期非鳞状NSCLC患者，目前奥希替尼仍作为一线治疗的优选方案推荐，同时新版指南更新一线治疗其他推荐方案：奥希替尼+培美曲塞+（顺柏/卡柏）（1类证据）。National Comprehensive Cancer Network*ECfRwon 1dtk>c orxon 21 LSMR EUUtIOntE3R mMatk>n discovofd prior toflrHin systemic thorapyProgrMonPrvfontdOSlfWttntt>s (category 1)f¼CQmmndtdb . p«wtrxd (cipaun or C4rt>optetin)or Erlotini (C4t0fy 1) or AfaUnibq, (CMOgory 1) or Gofttlnib" (tgory 1) or Dacomitiftlb9q (Catogofy 11 or Eriotinib ramucirumab or Ertotinib bvcUumbiProgressionComploto plannod systomk thfapy.n including mintennc thrapy. or Interrupt, followed by OSimoftinib (proforrd)ProgressionProgrMtionYlotlNb or "Inlb or gfltlnl or dacomitinib or rlotimb rmuckum*b or do<inlb bvactzumbraISyBtomk Thora>y. SubsequentNCCNGuidelinesVersion1.2024Non-SmallCellLungCancerEGFREXON19DELETIOHOREXON21L8MRMUTATlONSemFIRST.UNETHERAPYXEPryBe¾oMCM<3randftcwefAfWy¾¾(NSCLH)R*ofn,OfPqrMfctDirectedheraok¾ced<MecDceINScLj)SForPertormanoestatus0-4nCmehefortrewnemw<bevmt>nomquirnousNSCLC.andnofecrthtoryofhemop<yntAFDA*apfxowdbo*114rsanappropneieWtmMebbevuubIfyle<*cle<4yreg<nenc11lmNTmUneChedcporMrHMorphy>cmmhcMdbe8wereofr>elongMN-Me8u<tmM>reportingverM<v«ct»whenUilngo11wftnCCofnbnM8w«horfoown)cedortiMonTrof)eeflcuomno4i>.hghfw<m3montheScoMAj.，MnOnCX<20193OgM<0reYV*JAMAOncoiJOIM1112-1115OHWdGR«MnOnColmo.31507516Je“tcS.GJTborcOnctf20113133-137202EGFR耐药后治疗：Amivantamab联合化疗目前奥希替尼治疗后进展的EGFRExon19Del/Exon21L858R突变非鳞状NSCLC患者，无症状局部进展仍推荐局部治疗（立体定向消融放疗SABR或手术）或继续奥希替尼治疗。而多发性进展新增治疗方案：AmiVantamab+卡柏+培美曲塞推荐为优选方案（1类证据）。NCCN GUidetineS IndeXTabIe ol ContentS Discus.oaProgression on OSlmertInibuuProgross k>nt SoO therapy for multiple IleSionS,myy belowNCCNNational Comprehensive Cancer Network*NCCN Guidelines Version 1.2024Non-Small Cell Lung CancerNcCN GUttfelInM InaeXTable Of ContenS O$cu$s»onEGFREXON19DELETIONOREXON21L858RMUTATlONSmrnSUBSEQUENTTHERAPYMConsiderdefinitivelocaltherapy(eg,SABRorsurgery)forIimHedIosionsfla Continueimertinib Considerdefinitivelocaltherapy(eg.SRS)forlimitedIesionsvv ContinueOtimortinib NCCNGuidelinesforCNSCancers Considerdefinitivelocaltherapy(eg.SABRorsurgry)n ContinueOSimertinibor ThorapyformultipleIMionslbo<owAmivarrtamab.VmjwCart)OPlatMISystemicTherapy.pomotroxed(nonsquamous)-ProgressionSubsequentIytefloryl)(Pf城"red)HSCLK435)Systemictherapy""Adnocarclnoma(NSCLK1of5)SquamousCellCarcinoma(NsCL第235)nIGTAtherapy(eg.cryotherapy,microwave.rw>oreque*y)maybeanoptionforselectpaen(sPnnootes“ImaqeGiMfedThermal由曲OnTerapv(NSCLg)EBUQgP蚯QLMQ!"Kac侬电MMotecuterQCBomaMcrDrctedThefsoyAdvancedOrMetaSIaiICOSeaSe(NSCLJ)3BewareofflarepherxxnenonGsubsetOfpabentswodsconbnuetyrosinekraseohit>tf(TKI).IfdiseaseflareoccursrestartTKI“CilnCaItrialshaveincludedupto3to5PrOgreSSlngM5wwConsiderabiopsyattimeofprogressiontoruleoutsmallCealungCanOef(SCLC)transformation(appfQxvnalely6%>andbiopsyOCplasmatestingtoevaluatemechanismso(resistancePnn口pes。，MOlWoJ3,ar>J8。EarkCr33YSlS:NSCL-MIandNCCNGadellneSfor，nalCelLMqCa118<aAfatinecetuximabmaybeconsiderednaents*!hdiseaseprogressiononEGFRTKitherapy。ThedatainGeMCOnd5eSeSngsuggestthatprogrammeddeaf)MproteinI(PD104JmhiMocmo11(Xherapytslesseffective,rrespecteofPDL1expression.mEGFRexon19MebOnorexon21L85RALK*NSCLC03EGFR20ins一线治疗：Amivantamab联合化疗EGFRExon20ins突变非鳞状NSCLc患者的一线治疗,推荐系统性全身治疗。除此之外,指南更新一线治疗优选方案：AmiVamamab+卡钳+培美曲塞（1类证据）。ProgrMtionISystomk Thorapy, Subsequent I(NSCLK 4 d 5)ProgressionAmlvaumab>vmjwProgressionProgrossion AmhranUmab-vmjwEGFR axon 20 Insertion mutationAmivantamab-vmjw carboplatin/ Prwtroxdpp (nonsquamous) (CMegOfy 1) (PfeferTed)SUBSEQUENT THERAPYW)Systemic Therapy. SubsoqunLProgressionEGFREXON20INSERTIONMUTATlONmmFIRSLINETHERAPYCcCAdenocarcinon(NSCLKlQL5QSQuamousCellCetrciQQfflL(NsCLK2Of5】04ROS1重排:Repotrectinib在一线全身治疗前发现R0S1重排的患者，除了推荐恩曲替尼、克嘤替尼，一线治疗新增优选方案RepotrectiniE在一线全身治疗过程中发现R0S1重排的患者，在完成计划的全身治疗后，后续治疗除了推荐恩曲替尼、克嗖替尼和色瑞替尼，同样新增“优选方案”Repotrectinibo恩曲替尼、克嘤替尼、瑞普替尼或塞瑞替尼治疗后脑转移的R0S1重排患者,后续治疗新增优选方案”：RepotrectiniboNCCNFIRSLINE THERAPY叩SUBSEQUENT THERAPYPPROS1 rearrangementROS1 rearrangement discovered during first-line systemic thrapyROS1 rearrangement discovered prior to frstdine systemic therapy(Complete planned systemic therapy, including maintenance therapy, or interrupt. followed by ,ntroctiniM (preferred).Inib 9 电 trr>dl. Irepotrectinib'" (preferred)! Ior cerMn-ProflinW 一器 C0jjNational Comprehensive Cancer Network,NCCN Guidelines Version 1.2024Non-Small Cell Lung CancerNCCN GutdefcnM IndeXIdCfQtCC,'tfn K.D>css>onR0S1 REARRANGEMENVnmSUBSEQUENT THERAPYPP Consider definitive local therapy (eg. SABR or surgery) for Iimtted lesions%"AsymptomaticProgrosslonuu-22 on etrectinib. Crizotlnlbl repo(rectinib, or corltinibBrainSymptomaticUmtted progressionSystemickfJMII,IUlectinib. crizotinK). Ior crltinib LorIatinK) Consider definitive local therapy (eg. SRS) for limited te>k>n>vy Entrectinib oH previouslytroatod with czo(inib or corltinib) or Iorlatinib (if not previously given) NCCN GMigIing f<x CNS CanCQC Consider definitive local therapy (eg. SABR or surgery/VCQntinuoentroctinto. CriZOtl血 repotrectiniblor ceritinib Therapy for muttipke Mk>nst below Lorlatini)c Therapy Adenocardnoma (NSCL-K 1 Pt M or Squamous Cell Carcinoma (NSCK2jQLS)N8NGmdegsIndexTteoComtDiscussionMultiple lesions-SystemictherapyoptionsAdenocarcinoma(NsCLK1of5orSquamousCOllCarcinoma(NSCL-K2of5)05非鳞癌免疫治疗：Cemiplimab联合化疗CemiPIimab+培美曲塞+（卡箱/顺钳）（1类证据）:其他推荐方案”一优选方案。适用人群：PD-LI50%的腺癌.大细胞、NSCLC分型不明确（NOS）的一线治疗（PS0-2）oPDL11%49%的腺癌、大细胞.NSCLCNOS的一线治疗（PS0-2对PD1L1抑制剂无禁忌症的腺癌、大细胞、NSCLCNOS的全身性治疗（PS0-1）oNCCNGIidelineSdwxT>eo'ConIentSDtSCUSSiOCIMolecularandBiomarkerdirectedtherapyForadvancedormetastaticDs三ASEbPD-L1>50%First-LINETHERAPY(PS0-2)Adenocarcinoma,LargeCell,NSCLCNOSSquamousCellCarcinomaPretefred Pembrolizumab(categoryI)49-50 (CarboplatinorCiSPlatJn)<DemetrexedPembrDhZUmab(category1)51w Atezolizumab(category1产 CArninlimah-TwlcctAor1声Pretefred Pembrofczumab(categoryI)49-50 CartX)Plabn(PaCMaXH(Xalbumm-boundpaCfctaxeOPembrolizumab(categoryIr1 Alezolizumab(category1)s3 Cefmpfcmab-IWlc(category1)54 C甥IPwnabrwlcPaCfetaXei(CaIt)OPtetmordsplatm)(categoryOtherResmmended Nivokjmab÷ipmumabPaCMaXG÷Cart)OplatIn(category1)5 Tremelmumab-actldurvalumabCart)OPiatinatoumin-txjdpaclitaxel(category2B严 Tremelimumab-acU÷durvalumab+(CarbOPIatinorcisplatin)gemcitabine(category2B产USefUlInCena<ClrCUrnStanCeS Nivolumab÷ip三mumab(category1)0Cenplmab-fwic+pemetreed+(carboplatinordsplatm)(category1)5sI CartX)PIampadrtaxelbevacizumabceatezOiizumab(category1)5 CarbOi)Iatin*aft)umir>boundpaclitaxelatezokzumab57 Nivolumabipilimumab*pemetrexed÷(cart)oplatnOfdsplati)(category1)5 CefmpirnabwlcPaCMaXel(Cartx)PteROfsplatin)(category1)5 TremetanumaactldurvalumabCafbopiatin÷albumin4)undpaditaxel(category2B)5 TfemehmufYwb-actldurvalumab(Carboplatinorsplatn)peme<rexed(category2B严UsefulinCeftnCircumstanccs Nivolumab*Ipibmumab(category1)0PD-L150%FIRST-LINETHERAPY(PS3-4)fBestsupportivecare(NCCNGuidelinesforPaHiaUVeCare)PDL11%49%FDlnThomDyContinuationMaintenanceaMonitoringDuringInitialTherapyReSPOnSeassessmentalter2cycles,thenevery2-4cycleswithCTofknow<orhigh-risksitesofdiseaseMhorthouttrastormenclinicallyindicated.TlrwigofCTscansWtthinGuidelinesparametersisaclircaldecisionbMonilobngDurtngSubsequentTherapyorMatfttenanceTherapyResponseassessmentwithCToftarwwnaNghGskSdeSofdiseasewithorWnhoUtCenIraSlevery6-12weeksTimingo!CTscansvttr>nGUdeJinesarame<ersisaOnicaldecisioncAFDA-approvedbiosrmlarKSanappropnateSubsttuteforbevacizumab.*CrrteriaforIrealmentMthbevacizumab:nosquar>usNSCLC.andnorecenthistoryofhemoptysisfAlezolizufnabmonotherapyisatreatmentOPtionforpatientswithPS3.regardlessofPoLlstatus.No:AllrcommdMlonMC4tgcry2Auro,cwIndkMd.ClMUTrM:MCCNMvm5MthebM4mngwnMofywRScMllnClinkAl(rtPwttcipMSonMCftnMMpCnc0vr9d2OF*wtX04.IiQlOiOW>*MM>fC4nr*MMhCmmPCCM.MrtraMCCMhilBmMaa*t«wynMb*Fart»>vtow>v«*4»mwtta>»>am»CCN'VZr°PtBBWIannon12Q3fiO23113M3AMForRaMiuwor.N<xapo11PWdalr31OnOopynohtO2023KmfComprerwnewwJnCCrNatworK.Ec.MR<ytRtMrvedNational Comprehensive Cancer Network0NCCN Guidelines Version 1.2024Non-Small Cell Lung CancerNCCN GUidelineS IndeX lbe Of CQnten(S DiSCgiQfiMolecularandBiomarkerdirectedtherapyForadvancedormetastaticDISEASEabPD-L11%-49%FIRST-UNeTHERAPY(PS0-2)Adenocarcinoma,LargeCell,NSCLCNOSSquamousCellCarcinomaPreferredPrefefTed Carbopiabn(paditaxelOfalbumin-boundpaclitaxel)÷PembrolIZUmab(category1)1 Cemiplimat>rwlcpaclitaxel÷(carboplatinorCispiatin)(category1)5bOtherRecommended NivolumabipilimumabpaditaxelCarboplatvi(category1) Nivolumabipilimumab(category1严 Tremefcmumab-actl+durvalumab÷carboplatinalbumin-boundpaditaxel Tremefcmum>actldurvalumab(cart×>platinorCispiatin)gematabine59USefulinCertainCirCUmStance¾ PembrcMizumab(category2B)4950口，、：I，'q;:1I1：二：1",=>-<CMW2LO，,nEl*TVir>'*vSJf.tU%Tf1l!FTTl«Ifrr1不】五二,N1，：:v-,】ncdg】QjJH Cart)OPlatinpaditaxelbevacizumabceatezOkzumab(category1)fi Carboplatinalbumin-boundacMaelatezolzumab57 Ntvolumab÷lp*mumabpemetrexed(Cart)Oplatlnordsplat>)(category1)5 Nrvolumabipftmumab(category1严 CemipIimab-CWicpacMaxel(CarbOPlatinorcisplatin)(category1)5 Tremelimumab-aclldurvalumabcaop<ati÷atoumin-boundpaditaxel(category1)三 Tremelimumab-actldurvalumab(carboplatinorcisplatin)pemetrexed(category1)5UefulGCehalnCIrCUrnSlan8 Pembrolizumab(category2B)54ft50PD-L1>1%-49%FIRSTUNETHERAPY(PS3-4)*Bestsupportivecare(NCCNGUldenesforPaateCafe)PdLlN50%FnMineTheQDYCQnHnUMan_MelmenanCeMonitoringDuringlnialTherapy:Responseassessmentafter2cycles,thenevery2-4CyCieSMhCTofknownOrhigh-risksitesofdiseasevwtho<vthoutntrastorMienChmcaltyindicatedTimingofCTscans"thinGUBdehneSparametersisaclinicaldecisionbMonrtoringDuringSubsequentTherapyocMantenanceTherapyResponseassessmentwithCTofknownOrhigh-risksitesOrdiseasewithOrWrthoUtcontrastevery6-12weeks.TimingofCTscansthinGuideiinesparametersisadimcaldecisi.cAnFDA-approvedbiosimMarisanappropnatesubstituteforbevacuurnabCatenafortreatmentWrthbevacizumab:nosquamousNSCLC.andnorecenthistoryofhemoptysis.fAtezolizumabmonotherapyisatreatmentOPtiOnforpatentswithPS3.regardlessofPDL1status9PembrofczumabmonotherapycanbeconsideredinPD-LI1-49%.½*entherearecor三dicat>onstocombinatichemotherapyR伯nMoto：Allecomw<dM6areC4togory2AunlothonMIndtcaM.NSCL-J3 OF 6QtftlcaiTrMta:NCCNteUovM5atthbtEJnagBmor*ofanyp*ttntMhoncrt»InacMultrtal.ParticipationInctt3trUltIsMpociailyfl0>ura9Ml.>MwIMK，才GSOMffJMIW4(aCO.«(«««WVeeFXrerJw*MWP*MdrtataosUCKttaMlMAMorpvwWmmfP9nvdlOrOaMoaCBMnrB'JttlMMaraaCew*MWCa*MMMIaCAR*AaMrMRM-ENSCL-K1OF506鳞癌免疫治疗：Cemiplimab联合化疗CemiPIimab+紫杉醇+（卡钳/顺粕）（1类证据）:由其他推荐方案T优选方案。适用人群：PD-LI50%的鳞状细胞癌的一线治疗（PS0-2）oPDL11%49%的鳞状细胞癌的一线治疗（PS0-2）o对PD-1或PD-L1抑制剂无禁忌症得鳞状细胞癌的全身性治疗（PSO-DoNational CompreMnuvQ Cancet Network*NCCNGuidelinesVersion1.2024Non-SmallCellLungCancerIiOLECULARANDBIOMARKER-OIRECTEDTHERAPYFORADVANCEDORMETA5TAT1CDISEASEPOlIi5C4FIRST-LINtTMtRAPY俨SAj)A4oorcinom.L>r9C4l.NSCLCNOSSquwnoutCwcincnPrc*frK,PertxolKumeb(category1>4o(CMciuOrM11wresdpemtftaumb(cle90ry1产及 AteZOlzuffOb(c*ie90(y1产 Cemp"*b<*Mte90ry1)m CmPifnabvvtcp<n<r3cd(CJfbcpAMord0Ur)<ca90fy1严Jl"'Ru：MFkS二 Ca<nc*MM.bMctftn*bceMM(Azunwt)<CM90fy1产 CaftopnanItMnWVeOUndWMaJWaiczotoxn>b*7,NwkfT«b4x>mbPefnetreXed(carbopMnorsptattn>(cvte90ry Cmp*<nM>M4cCfU*i<Mto0atnorOHAMan)(Cgocylw Tre<nomr¾Cttdumkt)CafboPuOC*tjmm-boundPadRaNel(ce90ry2产 TmtmuruActldurvakfnab(CMt)oplBbnorCrtpUtinipmtrxd(category2B严UfclSOnifftwmm NMimb4Nimumab(cato90ry1f0EudfiOfid,PEfcRmEeb(category1严一0"CMopiM.(pct*xlOrAjbumbud(<MajoCPembraBUneb(category1>1A>ezou11¾b(Cele*y1)JC驾(阳VXWtC.p9c>w0d»(ct>(Mbnorspton)(categoryIOreeBtfiQflmCataJ,Nr5bpnu11wt>pocHae4BboMlC(CabegOry1严 Trw11*xnbcnUrrMbcwt×<tftt<terwvbour>dCOdiUieI(catogocy28)” Yrern9wmM>.M<krv9kjmM)(cM(t>Orp<tr>9emcUbr(an90ry2Bv* Nrvombipnum(cM90ry1*PO4.1150%FIRSt-UNETHERAPY(PSBMtsup(×MMar(NecNW(X*WWP*MgCt)CoflUouatKmMaintaoMMMonOxnflCv9EBalThervyRMPonteswewmen：.，/?getthenBeVy2-4CyCiMICTOqknOWnorhTvmtMmoftewewt<xm<co<*MtOrMfwndncfyv*cMIofCiC*wtm<adMpvewMcwtfdMnManrt)0wnS<jb<>j<Ther*>yMerterTher>y的w>onvMew<nlmt*CTofknoHnQrB<Mm*hcrh*qMICMw*rAlZMVCMTwngOtCTtc«wWfftnGMVmpv>11we<9naCkvca(e0wnCAnFDA*«pPaMebwkv.moqmbtuteMu.Ixbw*Mmb.OlWIcr.eMvwrtWtbcuf11*nor99MmouCLC.11noMK1呻o*Mnoctyut,AteUmEenQtherapy396*6t>rn*OP530CdPOXlUljfrltn-NM»Mi1-CMctfTrM*KC*MmwMttom三fw4«¾mm(«M>CM*caralaernlmCflMtuiWbIbm*mM¾*CMa>dRtftwencftSNSCL-J3 OF 6National Comprehensive Cancer Network®NCCN Guidelines Version 1.2024Non-Small Cell Lung CancerNCCN Gmdelines IndeX Tbe Of COntentS DISCUSSKXINCcN GUldeineS IndeX Tb? ” Contents D,¾cgcncolZ118iveNCCNGuidelinesVersion1.2024Network*NOn-SmaHCellLungCancerMolecularandbiomarker>directedtherapyForadvancedormetastaticdisease VMM. Ui03>-1Comn Cmv «mm«>C mtw NCeM f flMa* ，3 . C to*mm t £«p0Li1%-49%Firstunetherapy(pso-2)Adonocarcincxna.LargQCoil,NSCLCNOSSquamousCollCarcinomaPreMued(Cart×>piatnOCCtspIaOn)peme<rexedPembrotaImab(category1)AWB W Hn S 8 12JE342O23131 FB PvKrMl u f. Na (vrvwS KrO3IOn CoPyngrtO 2023 NMntf CCmprerVnM Cenoer NBho, Inc. All R)SrH RMrvvaPfetefredCartxjpiatr(pad<axelorat>umiM>oundPaClrtaXeOPentKoiaUmabOtfMyRCCOmmeded Cafbopiatinad<atibevacuumabcStezoazumab(Calegyl)5 CartXJpiatm