NCCN Updates Treatment Guideline for Small Cell Lung Cancer

10/19/18

The National Comprehensive Cancer Network has updated their guideline for small cell lung cancer to include new recommendations for surveillance, systemic therapy, and radiation therapy.

In the section for clinical stage I-IIA disease, a few changes were made. For the initial treatment of medically inoperable disease or the decision not to pursue surgical resection, “SABR or Systemic therapy plus concurrent RT” was added. For the adjuvant treatment of medically inoperable disease or the decision not to pursue surgical resection, “Systemic therapy” was added.

A couple of the bullets in the section for surveillance were updated. A new bullet was added: “Provide Survivorship Care Plan after completion of initial therapy.” Bullet 3 was revised to read, “MRI (preferred) or CT brain with contrast every 3-4 months during year 1, then every 6 months during year 2 (regardless of PCI status).”

Updates to the section for systemic therapy as primary or adjuvant therapy were focused on cisplatin and carboplatin. For limited stage disease, a maximum of four to six cycles is the recommendation for these regimens:

  • Cisplatin (75 mg/m2) day 1 and etoposide (100 mg/m2) days 1, 2, and 3
  • Cisplatin (25 mg/m2) days 1, 2, and 3 and etoposide (100 mg/m2) days 1, 2, and 3

“Cisplatin (80 mg/m2) day 1 and etoposide (100 mg/m2) days 1, 2, and 3” was removed from this section.

For extended state disease, a maximum of four to six cycles is the recommendation for “Carboplatin AUC 5 day 1 and etoposide (100 mg/m2) days 1, 2, 3 and atezolizumab (1200mg) day 1 every 21 days x four cycles followed by maintenance atezolizumab (1200 mg).” This recommendation was added with a Category 1 designation. A footnote was added to this section as well: “Regimen not recommended for relapsed disease in patients on maintenance atezolizumab at time of relapse. For patients who relapse after more than 6 months of atezolizumab maintenance therapy, recommend re-treatment with carboplatin AUC 5 day 1 and etoposide (110 mg/m2) days 1, 2, 3 alone."

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As a subsequent therapy option for relapse in less than or equal to 6 months, pembrolizumab was added with a Category 2A recommendation.

In the section for principles of radiation therapy, a “General Treatment Information” sub-section was introduced. A bullet was added for limited stage disease: “Selected patients with stage I-IIA small cell lung cancer who are medically inoperable or in whom a decision is made not to pursue surgery may be candidates for stereotactic ablative RT to the primary tumor followed by adjuvant systemic therapy. Principles of stereotactic ablative RT for small cell lung cancer are similar to those for non-small cell lung cancer.”—Zachary Bessette