Therapy for Stage IV Non-Small-Cell Lung Cancer With Driver Alterations: ASCO and OH (CCO) Joint Guideline Update
Therapy for Stage IV Non-Small-Cell Lung Cancer With Driver Alterations: ASCO and OH (CCO) Joint Guideline Update
复制标题
DOI：
10.1200/jco.20.03570
复制
发表时间：
2021-03-20
影响因子：
45.3
通讯作者：
Masters, Gregory
中科院分区：
文献类型：
--
作者：
Hanna, Nasser H.;Robinson, Andrew G.;Masters, Gregory
目的：为更新2017年ASCO关于IV期非小细胞肺癌（NSCLC）患者的系统治疗指南提供循证建议。一项关于IV期非小细胞肺癌患者的系统性治疗指南的更新单独发表。方法美国临床肿瘤学会和安大略卫生部（癌症护理安大略）NSCLC专家小组根据随机对照试验（RCT）的系统性综述更新了建议从2015年12月到2020年1月，以及ASCO 2020的会议摘要。结果本指南更新反映了自上次更新以来证据的变化。27项RCT、26项观察性研究和1项荟萃分析提供了证据基础（共54项）。关注的结局包括疗效和安全性。建议所有非鳞状NSCLC患者在实施晚期肺癌治疗前，无论吸烟状况如何，应尽可能遵循其他现有的高质量检测指南，进行潜在靶向突变（改变）的检测。大多数患者应接受针对这些改变的靶向治疗：应向患者提供针对ROS-1融合、BRAF V600 e突变、RET融合、MET 14号外显子跳跃突变和NTRK融合的靶向治疗，无论是作为一线治疗还是二线治疗（如果不在一线治疗中）。新的或修订的建议包括以下内容：奥希替尼是活化表皮生长因子受体突变（外显子19缺失、外显子21 L 858 R和外显子20 T790 M）患者的最佳一线治疗;阿来替尼或brigatinib是间变性淋巴瘤激酶融合患者的最佳一线治疗。据我们所知，该指南首次包括关于RET，MET和NTRK改变的建议。化疗仍然是大多数阶段的选择。
PURPOSE To provide evidence-based recommendations updating the 2017 ASCO guideline on systemic therapy for patients with stage IV non-small-cell lung cancer (NSCLC) with driver alterations. A guideline update for systemic therapy for patients with stage IV NSCLC without driver alterations was published separately.METHODS The American Society of Clinical Oncology and Ontario Health (Cancer Care Ontario) NSCLC Expert Panel updated recommendations based on a systematic review of randomized controlled trials (RCTs) from December 2015 to January 2020 and meeting abstracts from ASCO 2020.RESULTS This guideline update reflects changes in evidence since the previous update. Twenty-seven RCTs, 26 observational studies, and one meta-analysis provide the evidence base (total 54). Outcomes of interest included efficacy and safety. Additional literature suggested by the Expert Panel is discussed.RECOMMENDATIONS All patients with nonsquamous NSCLC should have the results of testing for potentially targetable mutations (alterations) before implementing therapy for advanced lung cancer, regardless of smoking status recommendations, when possible, following other existing high-quality testing guidelines. Most patients should receive targeted therapy for these alterations: Targeted therapies against ROS-1 fusions, BRAF V600e mutations, RET fusions, MET exon 14 skipping mutations, and NTRK fusions should be offered to patients, either as initial or second-line therapy when not given in the first-line setting. New or revised recommendations include the following: Osimertinib is the optimal first-line treatment for patients with activating epidermal growth factor receptor mutations (exon 19 deletion, exon 21 L858R, and exon 20 T790M); alectinib or brigatinib is the optimal first-line treatment for patients with anaplastic lymphoma kinase fusions. For the first time, to our knowledge, the guideline includes recommendations regarding RET, MET, and NTRK alterations. Chemotherapy is still an option at most stages.