Ramalingam Shares Notable Updates in NCCN Guidelines for EGFR+ NSCLC

Excerpt:

“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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Updates to NSCLC Guidelines Make Testing at Diagnosis, Resistance Essential

Excerpt:

“Updates to the National Comprehensive Cancer Network (NCCN) guidelines for the management of advanced non–small cell lung cancer (NSCLC) stress the importance of multiplexed biomarker testing at diagnosis to aid in the selection of appropriate first-line and subsequent lines of therapy, said presenters at the 2017 NCCN Annual Conference.

“The latest version of the guidelines recommends that PD-L1, in addition to molecular analysis, be employed as a biomarker to direct initial therapy, with ≥50% expression established as the threshold for a positive result. The PD-L1 test ‘decides whether a patient has enough of the marker to warrant initial immunotherapy,’ said presenter Gregory J. Riely, MD, PhD.”

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NCCN Publishes Patient Education Resources for Gliomas—Its First in a Series on Brain Cancer

Excerpt:

“January 9, 2017) The National Comprehensive Cancer Network® (NCCN®) has published the NCCN Guidelines for Patients® and NCCN Quick Guide™ sheets for Brain Cancer – Gliomas—the first in a series of patient education resources focused on Brain Cancer. Published by NCCN through support of the NCCN Foundation®, and, in part through funding from NCCN Foundation’s Team Pound the Pavement for Patients, these resources inform patients about their disease and the treatment options available to them.”

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

Excerpt:

“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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NCCN Adds New Gene Mutations to Consider in Women's Cancers

Excerpt:

“The National Comprehensive Cancer Network (NCCN) has added several new genetic mutations to be considered when determining risk-management strategies for hereditary breast and ovarian cancers.

“The recent discovery that the genetic mutation PALB2 is associated with an aggressive form of breast cancer, as well as the realization that the newer ovarian cancer genes RAD51CRAD51D, and BRIP1 pose an added lifetime risk for ovarian cancer, should prompt physicians to discuss possible prophylactic procedures with patients who are found to carry these mutations, Tuya Pal, MD, from the Moffitt Cancer Center, Tampa, Florida, said here at the NCCN 21st Annual Conference.

” ‘Within the past year, more data have emerged regarding these new genes for ovarian cancer risk. In the past, the NCCN recommendation to either recommend or consider risk-reducing salpingo-oophorectomy was limited to the presence of BRCA1BRCA2 and Lynch syndrome,’ Dr Pal told Medscape Medical News.”

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Relevancy of PD-L1 as a Biomarker for Immunotherapies in NSCLC

“Despite its initial running start, the continuing development of immunotherapies in the field of non-small cell lung cancer (NSCLC) won’t be slowing down anytime soon, according to Naiyer Rizvi, MD.

“ ‘The field is changing so fast,’ said Rizvi, director of Thoracic Oncology and Immunotherapeutics, Columbia University Medical Center, in an exclusive interview with Targeted Oncology. ‘Soon, we will have a better understanding of the first-line use of PD-1 agents, Then, maybe a year later, the data on the combination of PD-1/PD-L1 and CTLA-4 will come out. It is going to be a busy year. The NCCN [National Comprehensive Cancer Network] is going to be busy rewriting their guidelines every 6 months at this rate.’

“One immunotherapy currently being investigated is the anti–PD-1 agent pembrolizumab (Keytruda), in the KEYNOTE-024 study. The study is looking at pembrolizumab in the first-line setting for patients with stage IV metastatic NSCLC whose tumors express PD-L1.”


'Very Big Deal': NCCN Okays Watching More Prostate Cancer

“In a groundbreaking recommendation, the National Comprehensive Cancer Network (NCCN) has broadened the scope of prostate cancers that qualify for active surveillance in the United States to include men with ‘favorable’ intermediate-risk disease.

” ‘I think this is a very big deal,’ said James Mohler, MD, a urologist from Roswell Park Cancer Institute in Buffalo, New York, who is chair of the NCCN prostate cancer guideline panel.

“The recommendations of the NCCN are often followed by clinicians, insurers, and institutions, and the NCCN is the first major organization in the United States to make this recommendation.”


NCCN Recommends Only One Genomic Test for Breast Cancer

“The National Comprehensive Cancer Network (NCCN) only endorses one genomic test for use in patients with early-stage breast cancer, according to a presenter here at the NCCN 20th Annual Conference.

“Oncotype DX, a 21-gene assay from Genomic Health, has won that honor, said presenter Amy Cyr, MD, from the Siteman Cancer Center at Washington University in St. Louis, Missouri.

“The test serves two functions. In addition to providing a prognosis, the test has ‘some prediction capabilities in terms of therapy; it actually predicts a response to chemotherapy, compared with no chemotherapy,’ she explained.”


How A Group Of Lung Cancer Survivors Got Doctors To Listen

“A group of lung cancer survivors was chatting online last May about what they thought was a big problem: Influential treatment guidelines published by a consortium of prominent cancer centers didn’t reflect an option that several people thought had saved their lives. They wanted to change that.

“The guidelines from the National Comprehensive Cancer Network are important because they’re often a first stop for an oncologist trying to develop a treatment plan after a patient’s diagnosis, Chris Newman, one of the patient group’s members, told Shots. But the guidelines don’t always reflect newer and less proven treatment options that may be offered only at big academic cancer centers, she said. Patients might miss out on treatments that could help them, if the guidelines aren’t up to date.

“That’s what Newman and others thought was happening for some patients with a type of advanced non-small cell lung cancer. When cancer has spread, or metastasized, beyond the original site, it’s diagnosed as stage IV. And it’s historically been a pretty black and white diagnosis. With most forms of cancer, you have metastases or you don’t, says Paul Okunieff, a radiation oncologist and director of the University of Florida Health Cancer Center. Patients whose cancer has spread are often offered chemotherapy or supportive care rather than surgery or radiation to remove the tumors, on the assumption that it’s too late to prevent further spread.

“But some research suggests that patients with oligometastases, or a limited number of tumors (Okunieff says it’s fewer than three or five, depending on whom you ask) may get significant benefit from more aggressive treatment. That possibility wasn’t reflected in the NCCN guidelines.”