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ASCO/CCO Clinical Practice Guideline Update: Adjuvant Therapy for Resected Non–Small Cell Lung Cancers

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As reported in the Journal of Clinical Oncology by Mark G. Kris, MD, of Memorial Sloan Kettering Cancer Center, and colleagues, ASCO and Cancer Care Ontario (CCO) have issued an update to the ASCO/CCO clinical practice guideline on adjuvant systemic therapy and adjuvant radiation therapy for stage I to IIIA completely resected non–small cell lung cancer (NSCLC).

An expert panel was convened to update clinical practice guideline recommendations based on a systematic review of the literature. The evidence base includes a systematic review conducted by CCO through January 2016 and a recent ASCO-endorsed American Society for Radiation Oncology guideline and systematic review. The expert panel was co-chaired by Dr. Kris and Laurie E. Gaspar, MD, of the University of Colorado School of Medicine, Anschutz.

The updated recommendations are summarized/reproduced here. The type of recommendation, evidence quality, and strength of recommendation are shown in brackets.

Recommendations

Adjuvant systemic therapy for NSCLC:

  • Recommendation 1.1. Stage IA: Adjuvant chemotherapy is not recommended. [Type: evidence-based and panel consensus; harms outweigh benefits; evidence quality: moderate; strength of recommendation: strong]
  • Recommendation 1.2. Stage IB: Adjuvant cisplatin-based chemotherapy is not recommended for routine use. A postoperative multimodality evaluation, including a consultation with a medical oncologist, is recommended to assess the benefits and risks of adjuvant chemotherapy for each patient. Factors other than tumor stage to consider when making a recommendation for adjuvant chemotherapy are outlined after the adjuvant systemic therapy section of the guideline. [Type: evidence-based and panel consensus; benefits outweigh harms, especially in patients with larger tumors; evidence quality: intermediate; strength of recommendation: moderate]
  • Recommendation 1.3. Stages IIA/B and IIIA: Adjuvant cisplatin-based chemotherapy is recommended. (Type: evidence-based and panel consensus; benefits outweigh harms; evidence quality: high; strength of recommendation: strong]

Adjuvant radiation therapy for NSCLC:

  • Recommendation 2.1. Stages IA/B and IIA/B: Adjuvant radiation therapy is not recommended. [Type: evidence-based and panel consensus; harms outweigh benefits; evidence quality: intermediate; strength of recommendation: strong]
  • Recommendation 2.2. Stage IIIA (N2): Adjuvant radiation therapy is not recommended for routine use. A postoperative multimodality evaluation, including a consultation with a radiation oncologist, is recommended to assess the benefits and risks of adjuvant radiotherapy for each patient with N2 disease. [Type: evidence-based and panel consensus; benefits outweigh harms; evidence quality: intermediate; strength of recommendation: moderate]

The authors note that the updated recommendations do not differ substantively from the 2007 version of the guideline with regard to recommendations for or against the delivery of adjuvant therapy options across various disease stages. They state: “This updated version of the guideline does provide direction within the recommendations for a multimodality evaluation that includes a medical oncologist or a radiation oncologist for stage IB and IIIA resected NSCLCs, respectively.”

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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