The National Comprehensive Cancer Network (NCCN) and the International Association for the Study of Lung Cancer (IASLC) released an updated treatment guideline for non-small cell lung cancer (NSCLC) and treatment guidance for lung cancer patients during the COVID-19 pandemic, respectively.
In the NCCN guideline update, the algorithm for clinical presentation of advanced or metastatic NSCLC now lists “MET exon 14 skipping mutation” and “RET rearrangement” under testing and testing results.
A new page was added to address treatment recommendations for MET exon 14 skipping mutations. Capmatinib is listed as a “preferred” first-line and subsequent treatment option (category 2A), crizotinib is listed as a first-line and subsequent treatment option with a preference category of “useful in certain circumstances” (category 2A), and other systemic therapies are listed as first-line and subsequent treatment options with a preference category of “useful in certain circumstances” (category 2A).
Similarly, a new page was added to address treatment recommendations for RET rearrangement-positive disease. Selpercatinib was added as a “preferred” first-line and subsequent treatment option (category 2A), cabozantinib and vandetanib were added as first-line and subsequent treatment options with a preference category of “useful in certain circumstances” (category 2A), and other systemic therapies are listed as first-line and subsequent treatment options with a preference category of “other recommended” (category 2A).
In the section for emerging biomarkers to identify novel therapies for patients with metastatic NSCLC, both “MET exon 14 skipping mutation” and “RET rearrangement”—along with their associated references—were removed from the table.
In the section for targeted therapy for advanced or metastatic disease, capmatinib and crizotinib were added with references for “MET exon 14 skipping mutation.” Additionally, selpercatinib, cabozantinib, and vandetanib were added with references for “RET rearrangement.”
The IASLC guideline, published in the Journal of Thoracic Oncology (online May 15, 2020; doi:10/1016/j.jtho.2020.05.001), was designed to help oncologists address the many challenges that COVID-19-positive lung cancer patients present. A team of global lung cancer specialists convened to offer a review of lung cancer treatment for patients with COVID-19. These specialists stated that lung cancer patients—especially those with reduced lung function and cardiopulmonary comorbidities —are more likely to have increased risk and mortality from COVID-19.
“In combination with determining a treatment path for lung cancer, physicians should educate patients to help them prevent further spread of COVID-19 according to WHO and CDC guidelines,” authors of the study wrote, adding that evidence is lacking in many areas and that firmer recommendations are expected to be developed as more evidence becomes available.
“The decision regarding immediate vs delayed treatment during the COVID-19 pandemic should balance the delay of treatment in the presence of existing comorbidities vs the possible harm from COVID-19,” stated Chandra Belani, MD, chief science officer, IASLC, and lead author of the guideline, in a press release (May 15, 2020).—Zachary Bessette
