National Comprehensive Cancer Network
Non-Small Cell Lung Cancer, Version 4.2026, NCCN Clinical Practice Guidelines In Oncology
Ce document comprend 5 recommandations et 1 figure.
Contenu en anglais
Synthèse
In the US, an estimated 229,410 individuals will be diagnosed with lung cancer in 2026, with NSCLC accounting for approximately 87%. The 5-year overall survival rate is around 32%, influenced by factors like histology, disease stage, and the presence of actionable biomarkers.
Messages clés
Establish histologic subtype and conduct multigene panel testing (MGPT) before starting systemic therapy.
Targeted therapies are generally recommended as initial first-line therapy for patients with advanced or metastatic NSCLC and certain oncogenic drivers due to higher response rates compared to immune checkpoint inhibitors.
If an urgent start to therapy is needed while biomarker testing is pending, consider holding immunotherapy for one cycle and utilizing platinum-based chemotherapy.
Nouveautés de cette version
The panel has updated the list of recommended targeted therapies based on recent FDA approvals and clinical data.
Recommandations
Systemic Therapy for Advanced or Metastatic NSCLC with an Actionable Biomarker
Establish histologic subtype and conduct biomarker testing before starting systemic therapy.
Patients concernés: Patients with advanced or metastatic NSCLCSituation: Non-Small Cell Lung Cancer
Targeted therapies with a first-line indication (rather than first-line immune checkpoint inhibitors [ICIs]) are generally recommended as initial therapy for patients with advanced or metastatic NSCLC and certain oncogenic drivers, regardless of PD-L1 levels.
Patients concernés: Patients with advanced or metastatic NSCLC and certain oncogenic driversSituation: Non-Small Cell Lung Cancer
If patients require an urgent start to therapy and biomarker testing results are unknown or pending, clinicians should consider holding immunotherapy for one cycle (ie, use platinum-based chemotherapy regimens).
Patients concernés: Patients requiring an urgent start to therapy with unknown or pending biomarker testing resultsSituation: Non-Small Cell Lung Cancer
Figure 1. NSCL-19
For adenocarcinoma, large cell, or NSCLC not otherwise specified (NOS), conduct biomarker testing including EGFR mutation (category 1), ALK (category 1), KRAS, ROS1, BRAF, NTRK1/2/3, MET exon 14 skipping, RET (category 1), ERBB2 (HER2), NRG1, HER2 (IHC), and HGF receptor (c-Met) IHC as part of multigene panel testing (MGPT). Conduct PD-L1 testing (category 1).
Patients concernés: Patients with advanced or metastatic adenocarcinoma, large cell, or NSCLC NOSSituation: Non-Small Cell Lung Cancer
For squamous cell carcinoma, consider biomarker testing including EGFR mutation, ALK, KRAS, ROS1, BRAF, NTRK1/2/3, MET exon 14 skipping, RET, ERBB2 (HER2), NRG1, and HER2 (IHC) as part of MGPT. Conduct PD-L1 testing (category 1).
Patients concernés: Patients with advanced or metastatic squamous cell carcinomaSituation: Non-Small Cell Lung Cancer
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