NCCN 非小细胞 肺癌 - nccnchina.org

1 NCCN (NCCN ) 2015 7 NCCN. org2015 7 2015 6 11 , 2015 NCCN NCCN NCCN ANNUAL EDITION2015thNCCN NSCLC 2015 7 2015 6 11 , 2015 NCCN NCCN NCCN 2015 7 David S. Ettinger, MD/Chair The Sidney Kimmel Comprehensive Cancer Center at Johns HopkinsDouglas E. Wood, MD/Vice Chair Fred Hutchinson Cancer Research Center/Seattle Cancer Care AllianceWallace Akerley, MD Huntsman Cancer Institute at the University of UtahLyudmila A. Bazhenova, MD UC San Diego Moores Cancer CenterHossein Borghaei, DO, MS Fox Chase Cancer CenterDavid Ross Camidge, MD, PhD University of Colorado Cancer CenterRichard T. Cheney, MD Roswell Park Cancer InstituteLucian R.

2 Chirieac, MD Dana-Farber/Brigham and Women s Cancer CenterThomas A. D Amico, MD Duke Cancer InstituteTodd L. Demmy, MD Roswell Park Cancer InstituteThomas J. Dilling, MD Moffitt Cancer CenterM. Chris Dobelbower, MD, PhD University of Alabama at BirminghamComprehensive Cancer CenterRamaswamy Govindan, MD Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine Frederic W. Grannis, Jr. , MD City of Hope Comprehensive Cancer CenterLeora Horn, MD, MSc Vanderbilt-Ingram Cancer CenterThierry M. Jahan, MD UCSF Helen Diller Family Comprehensive Cancer CenterRitsuko Komaki, MD The University of Texas MD Anderson Cancer CenterLee M. Krug, MD Memorial Sloan Kettering Cancer Center Rudy P. Lackner, MD Fred & Pamela Buffett Cancer Center at The Nebraska Medical CenterMichael Lanuti, MD Massachusetts General Hospital Cancer CenterRogerio Lilenbaum, MD Yale Cancer Center/Smilow Cancer HospitalJules Lin, MD University of Michigan Comprehensive Cancer CenterBilly W.

3 Loo, Jr. , MD, PhD Stanford Cancer Institute Renato Martins, MD, MPH Fred Hutchinson Cancer Research Center/Seattle Cancer Care AllianceGregory A. Otterson, MD The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research InstituteJyoti D. Patel, MD Robert H. Lurie Comprehensive Cancer Center of Northwestern UniversityKatherine M. Pisters, MD The University of Texas MD Anderson Cancer CenterKaren Reckamp, MD, MS City of Hope Comprehensive Cancer CenterGregory J. Riely, MD, PhD Memorial Sloan Kettering Cancer CenterEric Rohren, MD, PhD фThe University of Texas MD Anderson Cancer CenterSteven E. Schild, MD Mayo Clinic Cancer CenterTheresa A. Shapiro, MD, PhD The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Scott J.

4 Swanson, MD Dana-Farber/Brigham and Women s Cancer Center Kurt Tauer, MDSt. Jude Children s Research Hospital/University of Tennessee Health Science CenterStephen C. Yang, MD The Sidney Kimmel Comprehensive Cancer Center at Johns HopkinsNCCNFay Ferkle, PharmDKristina Gregory, RN, MSNM iranda Hughes, PhD NCCN / / / ф / * ** : NCCN NCCN : NCCN : 2A NCCN NCCN (PREV-1) (DIAG-1) (NSCL-1) : I (T1ab-2a N0) II (T1ab-2ab N1 T 2 b N 0 ) I I B ( T 3 N 0 ) I I I A ( T 3 N 1 ) ( N S C L - 2 ) IIB (T3 N 0 ) I I I A ( T 4 N 0 - 1 T 3 N 1 ) ( N S C L - 4 ) IIIA (T1-3 N2) (IIB I I I A I V ) ( N S C L - 7 ) (NSCL-10) IIIB (T1-3 N3) (NSCL-11) IIIB (T4 N2-3) IV (M1a).

5 (NSCL-12) IV (M1b): (NSCL-13) (NSCL-14) (NSCL-15) (NSCL-16) (COL-A) (NSCL-B) (NSCL-C) (NSCL-D) (NSCL-E) (NSCL-F) (NSCL-G) (NSCL-H) (ST-1) NCCN NCCN (NCCN ) NCCN (National Comprehensive Cancer Network ) NCCN NCCN 2015 2015 7 2015 6 11 , 2015 NCCN NCCN NCCN 2015 7 NCCN NSCLC NCCN NSCLC 2015 7 2015 6 11 , 2015 NCCN NCCN 1/5 NCCN 2015 7 NCCN 2015 6 2015 7 NSCL-19 Nivolumab ccc PS 0-2 nivolumab 2B 2B 2B + 2B PS 3-4 NSCL-20 Nivolumab 2A 1 NSCL-F(2/3) Nivolumab NSCL-F(3/3)

6 25 26 MS-1 NCCN 2015 5 2015 6 NSCL-19 ccc PS 0-2 2B 2B 2B + 2B PS 3-4 NSCL-20 ddd PS 0-2 nivolumab 2B 2B + 2B PS 3-4 NCCN 2015 4 2015 5 NSCL-20 Nivolumab NSCL-F(3/3) Nivolumab NCCN 2015 3 2015 4 DIAG-2 NCCN NSCL-F(6/9) 3 SABR 5 NS NSCL-F(1/3) 1-2 2-4 MS-1 NCCN NSCLC 2015 7 2015 6 11 , 2015 NCCN NCCN 2/5 NCCN 2015 7 NCCN 2015 2 2015 3 : NSCL-19 NSCL-20 + 2B 2A NCCN 2015 1 2015 2 : NSCL-2 IIIA (T3 N1) NSCL-7 N1 ( NSCL-9) NSCL-8 T1-2 T3( 7 cm) N2 T1-2 T3( ) N2 NSCL-12 IIIB : (T4 N2-3) NCCN 2014 4 2015 1 DIAG-1 d : ( DIAG-2)DIAG-A 1/2 4 1 : ( ) 4 2 : (EUS) DIAG-A 2/2 1 1 5.

7 PET 1 1 7 : PET 1 2 : .. 1 3 2 : ( 1/3) 1 3 3 : (EBUS) (EUS) 1 3 3 : 2L 4L 5 7 8 9 1 3 4 : EUS 1 3 6 : NSCL-1 b : ( ) NSCL-2 l : ( NSCL-15) m : NSCL-13 aa : NCCN NSCLC 2015 7 2015 6 11 , 2015 NCCN NCCN NCCN 2015 7 NCCN 2014 4 2015 1 : NSCL-14 1.

8 3 CT ff : gg : FDG PET/CT NSCLC ( ) CT FDG PET/CT FDG PET/CT 2 FDG NSCL-16 hh : NCCN NSCLC NSCLC (NSCL-H) : EGFR ALK NSCL-17 NSCL-19 NSCL-20 NSCL-19 NSCL-20 p p : SCLC NSCL-18 ALK 2A 1 NSCL-19 NSCL-20 NSCL-19 NSCL-20 ll : 0-4 : / (NSCL-21) NSCL-19 : / / ( NSCL-20) : ( NSCL-20) : + 2B ( NSCL-20) yy : Grassino M, Martelli O, Broggini M, et al.

9 Erlotinib versus docetaxel as second lin-line treatment of patients with advanced NSCLC and wild type EGFR tumors (TAILOR): a randomized trial. Lancet Oncol 2013; 14: 981-988. ( NSCL-20) zz : EGFR EGFR NSCLC Gregorc V, Novello S, Lazzari C, et al. Predictive value of a proteomic signature in patients with non-small-cell lung cancer treated with second-line erlotinib or chemotherapy (PROSE): a biomarker stratified, randomised phase 3 trial. Lancet Oncol 2014; 15: 713-21. ( NSCL-20) 3/5 NCCN NSCLC 2015 7 2015 6 11 , 2015 NCCN NCCN 4/5 NCCN 2015 7 NCCN 2014 4 2015 1 : NSCL-19 bbb : 3-4 EGFR ( NSCL-20) ccc : 0-2 (2B ) (2B ) (2B ) 3-4 NSCL-20 ddd : 0-2 (2B ) (2B ) 3-4 NSCL-21 NSCL-19 NSCL-20 NSCL-A(1/4) 3 : WHO 4 : NSCLC ( [EGFR]) 5 : 6.

10 ( p63 p40) ( TTF-1 Napsin A) NSCL-A(2/4) 3 4 : TTF-1( Napsin A ) p63( p40 ) NSCLC 5 1 2 : CEA B72. 3 Ber-EP4 MOC31 CD15 claudin-4 TTF-1( ) NSCL-A(3/4) 1 2 : EGFR TKI 19 21(L858R L861) 18(G719X G719) 20(S768I) 1 4 : EGFR KRAS <1% 1 5 : KRAS 2 3 : ALK NSCLC (FISH) IHC , ALK ALK IHC ALK ALK 32,33 ALK ALCL ALK ALK FDA FISH ALK ALK ALK FISH NCCN NSCLC 2015 7 2015 6 11 , 2015 NCCN NCCN NCCN 2015 7 NCCN 2014 4 2015 1.