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1、最新2024v1版NCCN非小细胞肺癌指南更新（完整版）摘要近日，美国国家综合癌症网络（NCCN）发布了2024年首版非小细胞肺癌（NSCLC）临床实践指南。作为肿瘤诊疗领域最受关注的权威指南之一，NCCN指南的更新往往也反映着NSCLC治疗的关键动向和趋势。本次更新主要聚焦于EGFR、ROS1多靶点一线及耐药后治疗的6大治疗新理念，CCMTV小编特此整理。NationalComprehensiveNCCNCancerNetworkNCCNClinicalPracticeGuidelinesinOncology(NCCNGuidelines)Non-SmallCellLungCancerVer
2、sion1.2024December21.2023NCCN.orgNCCNGuidelinesforPatientseavailableatwww.nccn.org/patientsContinue（HEGFR突变一线治疗：奥希替尼联合化疗对于EGFRExon19Del/Exon21L858R突变的晚期非鳞状NSCLC患者，目前奥希替尼仍作为一线治疗的优选方案推荐，同时新版指南更新一线治疗其他推荐方案：奥希替尼+培美曲塞+（顺柏/卡柏）（1类证据）。National Comprehensive Cancer Network*ECfRwon 1dtkc orxon 21 LSMR EUUtIOn
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4、oto plannod systomk thfapy.n including mintennc thrapy. or Interrupt, followed by OSimoftinib (proforrd)ProgressionProgrMtionYlotlNb or Inlb or gfltlnl or dacomitinib or rlotimb rmuckum*b or doy. SubsequentNCCNGuidelinesVersion1.2024Non-SmallCellLungCancerEGFREXON19DELETIOHOREXON21L8MRMUTATlONSemFIR
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6、CX20193OgMnt SoO therapy for multiple IleSionS,myy belowNCCNNational Comprehensive Cancer Network*NCCN Guidelines Version 1.2024Non-Small Cell Lung CancerNcCN GUttfelInM InaeXTable Of ContenS O$cu$sonEGFREXON19DELETIONOREXON21L858RMUTATlONSmrnSUBSEQUENTTHERAPYMConsiderdefinitivelocaltherapy(eg,SABRo
7、rsurgery)forIimHedIosionsfla Continueimertinib Considerdefinitivelocaltherapy(eg.SRS)forlimitedIesionsvv ContinueOtimortinib NCCNGuidelinesforCNSCancers Considerdefinitivelocaltherapy(eg.SABRorsurgry)n ContinueOSimertinibor ThorapyformultipleIMionslbooreque*y)maybeanoptionforselectpaen(sPnnootes“Ima
8、qeGiMfedThermal由曲OnTerapv(NSCLg)EBUQgP蚯QLMQ!Kac侬电MMotecuterQCBomaMcrDrctedThefsoyAdvancedOrMetaSIaiICOSeaSe(NSCLJ)3BewareofflarepherxxnenonGsubsetOfpabentswodsconbnuetyrosinekraseohittf(TKI).IfdiseaseflareoccursrestartTKI“CilnCaItrialshaveincludedupto3to5PrOgreSSlngM5wwConsiderabiopsyattimeofprogres
9、siontoruleoutsmallCealungCanOef(SCLC)transformation(appfQxvnalely6%andbiopsyOCplasmatestingtoevaluatemechanismso(resistancePnn口pes。，MOlWoJ3,arJ8。EarkCr33YSlS:NSCL-MIandNCCNGadellneSfor，nalCelLMqCa118vmjwProgressionProgrossion AmhranUmab-vmjwEGFR axon 20 Insertion mutationAmivantamab-vmjw carboplatin
10、/ Prwtroxdpp (nonsquamous) (CMegOfy 1) (PfeferTed)SUBSEQUENT THERAPYW)Systemic Therapy. SubsoqunLProgressionEGFREXON20INSERTIONMUTATlONmmFIRSLINETHERAPYCcCAdenocarcinon(NSCLKlQL5QSQuamousCellCetrciQQfflL(NsCLK2Of5】04ROS1重排:Repotrectinib在一线全身治疗前发现R0S1重排的患者，除了推荐恩曲替尼、克嘤替尼，一线治疗新增优选方案RepotrectiniE在一线全身治疗
11、过程中发现R0S1重排的患者，在完成计划的全身治疗后，后续治疗除了推荐恩曲替尼、克嗖替尼和色瑞替尼，同样新增“优选方案”Repotrectinibo恩曲替尼、克嘤替尼、瑞普替尼或塞瑞替尼治疗后脑转移的R0S1重排患者,后续治疗新增优选方案”：RepotrectiniboNCCNFIRSLINE THERAPY叩SUBSEQUENT THERAPYPPROS1 rearrangementROS1 rearrangement discovered during first-line systemic thrapyROS1 rearrangement discovered prior to frstdine systemic therapy(Complete planned systemic therapy, including maintenance therapy, or inter
