最新2024v1版NCCN非小细胞肺癌指南更新（完整版）.docx

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1、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。NationalComprehensiveNCCNCancerNetworkNCCNClinicalPracticeGuidelinesinOncology(NCCNGuidelines)Non-SmallCellLungCancerVer

2、sion1.2024December21.2023NCCN.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 1dtkc orxon 21 LSMR EUUtIOn

3、tE3R mMatkn discovofd prior toflrHin systemic thorapyProgrMonPrvfontdOSlfWttntts (category 1)fCQmmndtdb . pwtrxd (cipaun or C4rtoptetin)or Erlotini (C4t0fy 1) or AfaUnibq, (CMOgory 1) or Gofttlnib (tgory 1) or Dacomitiftlb9q (Catogofy 11 or Eriotinib ramucirumab or Ertotinib bvcUumbiProgressionCompl

4、oto 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 doy. SubsequentNCCNGuidelinesVersion1.2024Non-SmallCellLungCancerEGFREXON19DELETIOHOREXON21L8MRMUTATlONSemFIR

5、ST.UNETHERAPYXEPryBeoMCM3randftcwefAfWy(NSCLH)R*ofn,OfPqrMfctDirectedheraokcedMecDceINScLj)SForPertormanoestatus0-4nCmehefortrewnemwnomquirnousNSCLC.andnofecrthtoryofhemopyntAFDA*apfxowdbo*114rsanappropneieWtmMebbevuubIfyle*cle4yregcmmhcMdbe8wereofrelongMN-Me8ureportingverM.hghfwm3montheScoMAj.，MnOn

6、CX20193OgMnt SoO therapy for multiple IleSionS,myy belowNCCNNational Comprehensive Cancer Network*NCCN Guidelines Version 1.2024Non-Small Cell Lung CancerNcCN GUttfelInM InaeXTable Of ContenS O$cu$sonEGFREXON19DELETIONOREXON21L858RMUTATlONSmrnSUBSEQUENTTHERAPYMConsiderdefinitivelocaltherapy(eg,SABRo

7、rsurgery)forIimHedIosionsfla Continueimertinib Considerdefinitivelocaltherapy(eg.SRS)forlimitedIesionsvv ContinueOtimortinib NCCNGuidelinesforCNSCancers Considerdefinitivelocaltherapy(eg.SABRorsurgry)n ContinueOSimertinibor ThorapyformultipleIMionslbooreque*y)maybeanoptionforselectpaen(sPnnootes“Ima

8、qeGiMfedThermal由曲OnTerapv(NSCLg)EBUQgP蚯QLMQ!Kac侬电MMotecuterQCBomaMcrDrctedThefsoyAdvancedOrMetaSIaiICOSeaSe(NSCLJ)3BewareofflarepherxxnenonGsubsetOfpabentswodsconbnuetyrosinekraseohittf(TKI).IfdiseaseflareoccursrestartTKI“CilnCaItrialshaveincludedupto3to5PrOgreSSlngM5wwConsiderabiopsyattimeofprogres

9、siontoruleoutsmallCealungCanOef(SCLC)transformation(appfQxvnalely6%andbiopsyOCplasmatestingtoevaluatemechanismso(resistancePnn口pes。，MOlWoJ3,arJ8。EarkCr33YSlS:NSCL-MIandNCCNGadellneSfor，nalCelLMqCa118vmjwProgressionProgrossion AmhranUmab-vmjwEGFR axon 20 Insertion mutationAmivantamab-vmjw carboplatin

10、/ 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

11、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 frst

12、dine systemic therapy(Complete planned systemic therapy, including maintenance therapy, or interrupt. followed by ,ntroctiniM (preferred).Inib 9 电 trrdl. Irepotrectinib (preferred)! Ior cerMn-ProflinW 一器 C0jjNational Comprehensive Cancer Network,NCCN Guidelines Version 1.2024Non-Small Cell Lung Canc

13、erNCCN GutdefcnM IndeXIdCfQtCC,tfn K.DcssonR0S1 REARRANGEMENVnmSUBSEQUENT THERAPYPP Consider definitive local therapy (eg. SABR or surgery) for Iimtted lesions%AsymptomaticProgrosslonuu-22 on etrectinib. Crizotlnlbl repo(rectinib, or corltinibBrainSymptomaticUmtted progressionSystemickfJMII,IUlectin

14、ib. crizotinK). Ior crltinib LorIatinK) Consider definitive local therapy (eg. SRS) for limited teknvy Entrectinib oH previouslytroatod with czo(inib or corltinib) or Iorlatinib (if not previously given) NCCN GMigIing fnst below Lorlatini)c Therapy Adenocardnoma (NSCL-K 1 Pt M or Squamous Cell Carci

15、noma (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P

16、D1L1抑制剂无禁忌症的腺癌、大细胞、NSCLCNOS的全身性治疗（PS0-1）oNCCNGIidelineSdwxTeoConIentSDtSCUSSiOCIMolecularandBiomarkerdirectedtherapyForadvancedormetastaticDs三ASEbPD-L150%First-LINETHERAPY(PS0-2)Adenocarcinoma,LargeCell,NSCLCNOSSquamousCellCarcinomaPretefred Pembrolizumab(categoryI)49-50 (CarboplatinorCiSPlatJn)Deme

17、trexedPembrDhZUmab(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)(categoryOth

18、erResmmended NivokjmabipmumabPaCMaXGCart)OplatIn(category1)5 Tremelmumab-actldurvalumabCart)OPiatinatoumin-txjdpaclitaxel(category2B严 Tremelimumab-acUdurvalumab+(CarbOPIatinorcisplatin)gemcitabine(category2B产USefUlInCenaboundpaclitaxelatezokzumab57 Nivolumabipilimumab*pemetrexed(cart)oplatnOfdsplati

19、)(category1)5 CefmpirnabwlcPaCMaXel(Cartx)PteROfsplatin)(category1)5 TremetanumaactldurvalumabCafbopiatinalbumin4)undpaditaxel(category2B)5 TfemehmufYwb-actldurvalumab(Carboplatinorsplatn)pemerexed(category2B严UsefulinCeftnCircumstanccs Nivolumab*Ipibmumab(category1)0PD-L150%FIRST-LINETHERAPY(PS3-4)f

20、Bestsupportivecare(NCCNGuidelinesforPaHiaUVeCare)PDL11%49%FDlnThomDyContinuationMaintenanceaMonitoringDuringInitialTherapyReSPOnSeassessmentalter2cycles,thenevery2-4cycleswithCTofknownGUdeJinesarameusNSCLC.andnorecenthistoryofhemoptysisfAlezolizufnabmonotherapyisatreatmentOPtionforpatientswithPS3.re

21、gardlessofPoLlstatus.No:AllrcommdMlonMC4tgcry2Auro,cwIndkMd.ClMUTrM:MCCNMvm5MthebM4mngwnMofywRScMllnClinkAl(rtPwttcipMSonMCftnMMpCnc0vr9d2OF*wtX04.IiQlOiOW*MMfC4nr*MMhCmmPCCM.MrtraMCCMhilBmMaa*twynMb*Fartvtowv*4mwttaamCCNVZrPtBBWIannon12Q3fiO23113M3AMForRaMiuwor.Nxapo11PWdalr31OnOopynohtO2023KmfComp

22、rerwnewwJnCCrNatworK.Ec.MRrwlcpaclitaxel(carboplatinorCispiatin)(category1)5bOtherRecommended NivolumabipilimumabpaditaxelCarboplatvi(category1) Nivolumabipilimumab(category1严 Tremefcmumab-actl+durvalumabcarboplatinalbumin-boundpaditaxel Tremefcmumactldurvalumab(cartplatinorCispiatin)gematabine59USe

23、fulinCertainCirCUmStance PembrcMizumab(category2B)4950口，、：I，q;:1I1：二：1,=-*vSJf.tU%Tf1l!FTTlIfrr1不】五二,N1，：:v-,】ncdg】QjJH Cart)OPlatinpaditaxelbevacizumabceatezOkzumab(category1)fi Carboplatinalbumin-boundacMaelatezolzumab57 Ntvolumablp*mumabpemetrexed(Cart)Oplatlnordsplat)(category1)5 Nrvolumabipftmu

24、mab(category1严 CemipIimab-CWicpacMaxel(CarbOPlatinorcisplatin)(category1)5 Tremelimumab-aclldurvalumabcaop1%-49%FIRSTUNETHERAPY(PS3-4)*Bestsupportivecare(NCCNGUldenesforPaateCafe)PdLlN50%FnMineTheQDYCQnHnUMan_MelmenanCeMonitoringDuringlnialTherapy:Responseassessmentafter2cycles,thenevery2-4CyCieSMhC

25、TofknownOrhigh-risksitesofdiseasevwthoonstocombinatichemotherapyR伯nMoto：Allecomwura9Ml.MwIMK，才GSOMffJMIW4(aCO.(WVeeFXrerJw*MWP*MdrtataosUCKttaMlMAMorpvwWmmfP9nvdlOrOaMoaCBMnrBJttlMMaraaCew*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%

26、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.Lr9C4l.NSCLCNOSSquwno

27、utCwcincnPrc*frK,PertxolKumeb(category14o(CMciuOrM11wresdpemtftaumb(cle90ry1产及 AteZOlzuffOb(c*ie90(y1产 Cemp*b*Mte90ry1)m CmPifnabvvtcpnr3cd(CJfbcpAMord0Ur)ca90fy1严JlRu：MFkS二 Canc*MM.bMctftn*bceMM(Azunwt)b*7,NwkfTb4xmbPefnetreXed(carbopMnorsptattn(cvte90ry Cmp*M4cCfU*iMto0atnorOHAMan)(Cgocylw Trenomr

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29、4BboMlC(CabegOry1严 Trw11*xnbcnUrrMbcwttfttdCOdiUieI(catogocy28)” Yrern9wmM.MOrp9emcUbr(an90ry2Bv* Nrvombipnum(cM90ry1*PO4.1150%FIRSt-UNETHERAPY(PSBMtsup(MMar(NecNW(X*WWP*MgCt)CoflUouatKmMaintaoMMMonOxnflCv9EBalThervyRMPonteswewmen：.，/?getthenBeVy2-4CyCiMICTOqknOWnorhTvmtMmoftewewtxmco*MtOrMfwndncfyv

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31、nes IndeX Tbe Of COntentS DISCUSSKXINCcN GUldeineS IndeX Tb? ” Contents D,cgcncolZ118iveNCCNGuidelinesVersion1.2024Network*NOn-SmaHCellLungCancerMolecularandbiomarkerdirectedtherapyForadvancedormetastaticdisease VMM. Ui03-1Comn Cmv mmC mtw NCeM f flMa* ，3 . C to*mm t p0Li1%-49%Firstunetherapy(pso-2)

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