Updated NCCN Guidelines include maintenance therapy for patients with metastatic disease

The National Comprehensive Cancer Network (NCCN) recently updated the NCCN Guidelines for Non-Small Cell Lung Cancer (NSCLC) to incorporate a new section about maintenance therapy, a number of new indications for specific therapies for advanced NSCLC, and the recently revised staging system for lung cancer. Lung cancer remains the leading cause of cancer death in the United States.

The updated NCCN Guidelines now include a description of maintenance therapy for patients with advanced or metastatic disease. Maintenance therapy refers to treatment that prevents a cancer from spreading after it has responded to initial treatments with chemotherapy (usually 4 to 6 rounds of treatment). This new section helps distinguish between recommended therapies for continuation maintenance versus switch maintenance.

Noteworthy updates to the NCCN Guidelines involving specific therapies for advanced NSCLC include:

• The addition of erlotinib (Tarceva(R), Genentech BioOncology and OSI Oncology) as a first-line treatment option for EGFR mutation positive patients with advanced or metastatic disease.
• Bevacizumab (Avastin(TM), Genentech BioOncology) and cetuximab (Erbitux(R), Bristol-Myers Squibb Company and ImClone Systems Incorporated) have been added as treatment options for continuation maintenance with a category 1 designation.
• Pemetrexed (Alimta(R), Eli Lilly & Company) and erlotinib have been added as treatment options for switch maintenance with a category 2B designation and docetaxel (Taxotere(R), sanofi-aventis, U.S.) has been added with a category 3 designation.

The international staging system for lung cancer was recently revised and has been incorporated into the updated NCCN Guidelines. Staging provides the basis for evaluating a patient's prognosis and is a valuable aid in the treatment selection of patients with lung cancer. The revised system more accurately reflects a patient's prognosis and current practice. The new staging will affect one out of every six lung cancer patients and takes effect January 1, 2010.

The NCCN Clinical Practice Guidelines in Oncology(TM) are developed and updated through an evidence-based process with explicit review of the scientific evidence integrated with expert judgment by multidisciplinary panels of physicians from NCCN Member Institutions. The most recent version of this and all the NCCN Guidelines are available free of charge at NCCN.org.