Ramalingam Shares Notable Updates in NCCN Guidelines for EGFR+ NSCLC


“Among the notable updates in the National Comprehensive Cancer Network’s (NCCN) recently released  treatment guidelines for non–small cell cancer (NSCLC) is the category 2A recommendation to give osimertinib (Tagrisso), a third-generation irreversible EGFR inhibitor designed to inhibit both EGFR-sensitizing and EGFR T790M-resistance mutations, in the first-line setting for patients whose disease is EGFR mutant, explains Suresh A. Ramalingam, MD.

“Osimertinib was also given a category 1 recommendation as a subsequent therapy after patients progressed on treatment with standard EGFR tyrosine kinase inhibitors (TKIs) erlotinib (Tarceva), gefitinib (Iressa), and afatinib (Gilotrif). The FDA granted a breakthrough therapy designation to a supplemental biologics license application for osimertinib as a frontline treatment for patients with metastatic EGFR-mutation–positive NSCLC in October 2017. The application was based on findings from the double-blind, phase III FLAURA trial, in which frontline osimertinib was associated with a 54% reduction in the risk of progression or death compared with standard therapy.”

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Guideline on Stage IV Non-Small-Cell Lung Cancer Therapy Updated


“An update of the American Society of Clinical Oncology (ASCO) clinical practice guideline clarifies the role of immunotherapy in the treatment of patients with advanced non-small-cell lung cancer (NSCLC). The update also provides new recommendations on the use of targeted therapies for patients with changes in tumor EGFRALK, and ROS1 genes.

” ‘Treatment for lung cancer has become increasingly more complex over the last several years. This guideline update provides oncologists the tools to choose therapies that are most likely to benefit their patients,’ said Nasser Hanna, MD, co-chair of the Expert Panel that developed the guideline update.”

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New Guidelines Aim Treat Brain Tumors More Effectively


“A University of Portsmouth academic has helped to develop European guidelines to treat brain tumours more effectively.

“Geoff Pilkington, Professor of Cellular and Molecular Neuro-oncology and one of the UK’s leading brain tumour specialists, was one of only three UK academics who devised the European Association for Neuro-Oncology (EANO) guidelines on the diagnosis and  of  with astrocytic and oligodendroglial gliomas, including glioblastomas.”

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Stage IIIA Non-Small Cell Lung Cancer Survival Rates Improved When Care Includes Four Specific Quality Measures


“Current guidelines from the National Comprehensive Cancer Network (NCCN) and American College of Chest Physicians (ACCP) recommend that operable patients with clinical Stage IIIA non-small cell lung cancer (NSCLC) should receive induction chemotherapy (with or without concurrent radiotherapy) followed by resection if there is no apparent progression of disease. While four quality measures have been identified as associated with improved overall survival, until now it has been unclear to what extent patients are actually receiving each of these measures as part of their care. A presentation at the 96th AATS Annual Meeting clearly demonstrates that survival rates increase as more quality measures are incorporated into patient care – but only 13% of eligible patients actually received all four measures.”

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ASCO Recommends Ovarian Suppression for ER-Positive Breast Cancer

“An American Society of Clinical Oncology (ASCO) expert panel issued an updated guideline recommending that higher-risk premenopausal women with estrogen receptor (ER)-positive breast cancer receive ovarian suppression in addition to adjuvant endocrine therapy. Lower-risk patients, however, should not receive ovarian suppression.

“ ‘In the past year, randomized trials with robust methodological designs have analyzed the effect of ovarian suppression among premenopausal women with ER-positive breast cancers treated with tamoxifen,’ wrote the panel, led by ASCO expert Harold J. Burstein, MD, PhD, of Dana-Farber Cancer Institute in Boston. In the past, studies of this therapy have suffered from problems such as selection criteria confounding.

“The guideline update is based on four randomized controlled trials. These include the Eastern Cooperative Oncology Group 3193 (E-3193) trial, the Suppression of Ovarian Function Trial (SOFT), the Tamoxifen and Exemestane Trial (TEXT), and the Austrian Breast Cancer Study Group (ABCSG)-12 trial. Overall, the studies did not find a significant difference with regard to overall survival between tamoxifen alone, tamoxifen plus ovarian suppression, or aromatase inhibitors (AIs) plus ovarian suppression. The guideline update was published in the Journal of Clinical Oncology.”

ASCO Endorses Localized Prostate Cancer Guideline

“A panel of experts at the American Society of Clinical Oncology (ASCO) have reviewed and endorsed Cancer Care Ontario’s guideline on Active Surveillance for the Management of Localized Prostate Cancer. They are published in the Journal of Clinical Oncology.

“The guidelines, published in May 2015, ‘are clear, thorough, and based upon the most relevant scientific evidence,’ wrote Ronald C. Chen, MD, MPH, associate professor in the department of radiation oncology at UNC-Chapel Hill, and coauthors. ASCO endorsed all aspects of the guideline except for the recommendation on use of 5-alpha reductase inhibitors.”

ASCO Issues New Guideline on Use of Biomarkers to Guide Early Breast Cancer Therapy Decisions

“The American Society of Clinical Oncology (ASCO) today issued a new clinical practice guideline for women with early-stage invasive breast cancer and known hormone receptor and human epidermal growth factor 2 (HER2) receptor status. The guideline includes evidence-based recommendations on the appropriate use of breast tumor biomarker tests to guide decisions on adjuvant systemic therapy.

” ‘In the era of precision medicine, the role of biomarkers in guiding clinical care is greater than in the past. An extensive number of new tests have come out in the last 5-10 years, but not all have sufficient evidence of clinical utility,’ said Lyndsay N. Harris, MD, co-chair of the ASCO expert panel that developed the guideline. ‘These latest recommendations truly inform physicians about which tests need to be performed. But this is not all that goes into patient care—doctors need to continue discussions with patients to develop individualized treatment plans.’ “

Targeted Axillary Dissection of Lymph Nodes after Chemotherapy Improves Staging Accuracy of Node-Positive Breast Cancer

“A new procedure developed by surgeons at The University of Texas MD Anderson Cancer Center improves the accuracy of axillary staging and pathologic evaluation in clinically node-positive breast cancer, and reduces the need for a more invasive procedure with debilitating complications.

“The research, published in the Journal of Clinical Oncology, has changed treatment guidelines at the institution for a select group of breast cancer patients with lymph node metastasis, who will now receive Targeted Axillary Dissection (TAD).

“The TAD procedure involves removing sentinel lymph nodes, as well as additional cancerous lymph nodes found during diagnosis. At the time of diagnosis, those select nodes are clipped for identification during later surgery.”

ASCO Updates Guidelines for Antiemetics During Chemo

“For patients receiving chemotherapy, the use of the oral combination of netupitant (a neurokinin 1 receptor antagonist) and palonosetron (a 5-hydroxytryptamine-3 receptor antagonist) is beneficial for prevention of acute and delayed nausea and vomiting, according to a focused guideline update published online Nov. 2 in the Journal of Clinical Oncology.

“Paul J. Hesketh, M.D., from the Lahey Hospital and Medical Center in Burlington, Mass., and colleagues conducted a targeted systematic literature review to update guidelines on use of the oral combination of netupitant and palonosetron for prevention of acute and delayed nausea and vomiting among patients receiving chemotherapy.”