Non–Small Cell Lung Cancer: Recommendations for Biomarker Testing and Treatment

Presented by:
Dara L. Aisner
Search for other papers by Dara L. Aisner in
Current site
Google Scholar
PubMed Close
 MD, PhD
and
Gregory J. Riely
Search for other papers by Gregory J. Riely in
Current site
Google Scholar
PubMed Close
 MD, PhD
Volume/Issue:
Volume 19: Issue 5.5
Online Publication Date:
17 May 2021
DOI:
https://doi.org/10.6004/jnccn.2021.5020
Restricted access

Updates to the NCCN Guidelines for Non–Small Cell Lung Cancer (NSCLC) for 2021 include recommendations for biomarker testing in all appropriate patients with newly diagnosed advanced lung cancer, including squamous cell lung cancer. When a targetable genetic alteration is detected, the NCCN Guidelines recommend treatment with a first-line therapy targeted to that alteration. The guidelines contain new information on use of adjuvant treatment with osimertinib for resected early-stage EGFR-mutated NSCLC. New targeted agents are now recommended for the treatment of ALK rearrangements, RET alterations, MET exon 14 skipping mutations in patients with advanced NSCLC; and new immunotherapy agents are recommended for advanced NSCLC without a driver oncogene.

Disclosures: Dr. Aisner has disclosed receiving honoraria from Blueprint Medicines and grant/research support from Genentech, Inc. Dr. Riely has disclosed receiving grant/research support from Merck & Co., Inc., Mirati Therapeutics, Inc., Novartis Pharmaceuticals Corporation, Pfizer Inc., Roche Laboratories, Inc., and Takeda Pharmaceuticals North America, Inc.

Correspondence: Dara L. Aisner, MD, PhD, University of Colorado Cancer Center, 12705 East Montview Boulevard, Suite 400, Aurora, CO 80045. Email: dara.aisner@cuanschutz.edu; and
Gregory J. Riely, MD, PhD, Memorial Sloan Kettering Cancer Center, 530 East 74th Street, New York, NY 10021. Email: rielyg@mskcc.org
  • Collapse
  • Expand
Print ISSN:
1540-1405
Online ISSN:
1540-1413
Publisher:
National Comprehensive Cancer Network
Cover Journal of the National Comprehensive Cancer Network
  • 1.

    Cheung AH, Tong JH, Chung LY, et al. EGFR mutation exists in squamous cell lung carcinoma. Pathology 2020;52:323–328.

  • 2.

    Ho HL, Kao HL, Yeh YC, Chou TY. The importance of EGFR mutation testing in squamous cell carcinoma or non-small cell carcinoma favor squamous cell carcinoma diagnosed from small lung biopsies. Diagn Pathol 2019;14:59.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3.

    Lu S, Lu C, Xiao Y, et al. Comparison of EML4-ALK fusion gene positive rate in different detection methods and samples of non-small cell lung cancer. J Cancer 2020;11:1525–1531.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4.

    Wu YL, Tsuboi M, He J, et al. Osimertinib in resected EGFR-mutated non-small-cell lung cancer. N Engl J Med 2020;383:1711–1723.

  • 5.

    Benayed R, Offin M, Mullaney K, et al. High yield of RNA sequencing for targetable kinase fusions in lung adenocarcinoma with no mitogenic driver alterations detected by DNA sequencing and low tumor burden. Clin Cancer Res 2019;25:4712–4722.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6.

    Hong DS, Fakih MG, Strickler JH, et al. KRAS G12C inhibition with sotorasib in advanced solid tumors. N Engl J Med 2020;383:1207–1217.

  • 7.

    Aggarwal C, Rolfo CD, Oxnard GR, et al. Strategies for successful implementation of plasma-based NSCLC genotyping in clinical practice. Nat Rev Clin Oncol 2021;18:56–62.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8.

    Soria JC, Ohe Y, Vansteenkiste J, et al. Osimertinib in untreated EGFR-mutated advanced non-small-cell lung cancer. N Engl J Med 2018;378:113–125.

  • 9.

    Ramalingam SS, Vansteenkiste J, Planchard D, et al. Overall survival with osimertinib in untreated, EGFR-mutated advanced NSCLC. N Engl J Med 2019;382:41–50.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10.

    Saito H, FukiharaT, Furuya N, et al. Erlotinib plus bevacizumab versus erlotinib alone in patients with EGFR-positive advanced non-squamous non-small cell lung cancer: interim analysis of an open-label randomized, multicenter, phase 3 trial. Lancet Oncol 2019;20:625–635.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11.

    Nakagawa K, Garon EB, Seto T, et al. Ramucirumab plus erlotinib in patients with untreated EGFR-mutated, advanced non-small cell lung cancer (RELAY): a randomized, double-blind, placebo-controlled phase 3 trial. Lancet Oncology 2019;20:1655–1669.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12.

    Solomon BJ, Mok T. First-line crizotinib in ALK-positive lung cancer. N Engl J Med 2015;372:782.

  • 13.

    Peters S, Camidge DR, Shaw AT, et al. Alectinib versus crizotinib in untreated ALK-positive non-small-cell lung cancer. N Engl J Med 2017;377:829–838.

  • 14.

    Camidge DR, Kim HR, Ahn MY, et al. Brigatinib versus crizotinib in ALK-positive non-small-cell lung cancer. N Engl J Med 2018;379:2027–2039.

  • 15.

    Shaw AT, Bauer TM, de Marinis F, et al. First-line lorlatinib or crizotinib for ALK-positive lung cancer. N Engl J Med 2020;383:2018–2029.

  • 16.

    Drilon A, Clark JW, Weiss J, et al. Antitumor activity of crizotinib in lung cancers harboring a MET exon 14 alteration. Nat Med 2020;26:47–51.

  • 17.

    Wolf J, Seto T, Han JY, et al. Capmatinib (INC280) in MET exon-14 mutated advanced non-small cell lung cancer (NSCLC): efficacy data from the phase II GEOMETRY mon-1 study [abstract]. J Clin Oncol 2019;37(Suppl):Abstract 9004.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18.

    Paik PH, Felip E, Veillon R, et al. Tepotinib in non-small-cell lung cancer with MET exon 14 skipping mutations. N Engl J Med 2020;383:931–943.

  • 19.

    Drilon A, Oxnard GR, Tan DSW, et al. Efficacy of selpercatinib in RET fusion-positive non-small-cell lung cancer. N Engl J Med 2020;383:813–824.

  • 20.

    Gainor J, Curigliano G, Kim DW, et al. Registration dataset from the phase I/II ARROW trial of pralsetinib (BLU-667) in patients with advanced RET fusion+ non-small cell lung cancer (NSCLC) [abstract]. J Clin Oncol 2020;38(Suppl):Abstract 9515.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21.

    Paz-Ares L, Ciuleanu TE, Cobo M, et al. First-line nivolumab plus ipilimumab combined with two cycles of chemotherapy in patients with non-small-cell lung cancer (CheckMate 9LA): an international, randomized, open-label, phase 3 trial. Lancet Oncol 2021;22:198–211.

    • PubMed
    • Search Google Scholar
    • Export Citation
Copyright:
Copyright © 2021 by the National Comprehensive Cancer Network 2021
Page Numbers:
4
Article Category:
Research Article
Print Publication Date:
01 May 2021
Online Publication Date:
17 May 2021

Metrics

All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 18611 6412 257
PDF Downloads 15564 5053 156
EPUB Downloads 0 0 0