Click here to view as PDF.The National Comprehensive Cancer Network ConferenceClinical Practice Guidelines and Quality Cancer Care
The National Comprehensive Cancer Network (NCCN) 13th Annual Conference: Clinical Practice Guidelines and Quality Cancer Care, was held in Hollywood, Florida, from March 5–9, 2008. The conference provided attendees with updates to the NCCN’s Clinical Practice Guidelines in Oncology, protocols that, according to the organization (a not-for-profit alliance of 21 of the world’s leading cancer centers), currently cover the management of more than 97% of all cancer patients. Updated treatment guidelines were presented for an array of disease states, including breast cancer, leukemia, colon and rectal cancer, kidney cancer, multiple myeloma, and lung cancer.
The conference also featured cutting-edge data from recent academic research and clinical trials and discussions of and presentations on new therapies. Other sessions focused on quality issues and initiatives related to cancer care and emerging economic challenges related to fiscal issues and oncology business management. In addition, expert faculty presented newly released NCCN task force reports, and participated in roundtable discussions. Numerous satellite symposia, networking events, and a major exhibition of various and varied oncology vendors (including pharmaceutical manufacturers, medical device concerns, biotechnology companies, health care publishers, patient advocacy organizations, and managed care companies) were also featured.
The meeting was attended by roughly 1,300 practicing oncologists, oncology fellows, scientists, researchers, academicians, key opinion leaders and other cancer care professionals (i.e., nurses, physician assistants, pharmacists, administrators) as well as patient group, physician group, employer group, and government agency representatives from around the globe. The following sections provide a general overview of breaking news and session highlights from the conference.
â–º Advances in Lung CancerUpdates to NSCLC Guidelines
David S. Ettinger, MD, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland, and Mark G. Kris, MD, Memorial Sloan Kettering Cancer Center, New York City, provided an update” to NCCN’s Non-Small Cell Lung Cancer (NSCLC) Guidelines, which were released in October 2007.
Dr. Ettinger began the presentation with a summary review of the changes that have occurred in the NCCN’s NSCLC Guidelines as a result of the recent update. Several changes took place in the realm of postoperative adjuvant treatment (NSCL-3) for early-stage NSCLC. In stage IA, margins negative, “the recommendation for chemotherapy for high-risk patients was changed to a category three,” reported Dr. Ettinger. In stage IA, margins positive, Dr. Ettinger related that “the recommendation for chemotherapy after re-resection was changed to a category three.” For stage IIIA, margins negative, “the recommendation for chemoradiation followed by chemotherapy was removed. Mediastinal radiation therapy (RT) was added to chemotherapy.”
Some of the other guideline changes Dr. Ettinger highlighted included the following: “For stage IIIB (resectable other than satellite), the recommendation for chemotherapy followed by chemoradiation was added for R1, R2 disease after initial treatment with surgery (NSCL-8).” Under the ‘Therapy for Recurrence and Metastasis (NSCL-13)’ section of the guidelines, “PS2 patients were removed from the grouping with PSO and 1 patients and their recommended treatment is chemotherapy.” Also, a clarification was added (as footnote ‘w’) that bevacizumab (Avastin) should not be used as a single agent, “unless as maintenance, if initially used with chemotherapy.”
The updated version of the NCCN guidelines also contained several therapy-specific alterations. These revisions included:
The designation of cisplatin/etoposide (Etopophos) and cisplatin/vinblastine (Velban) as preferred (in adjuvant therapy) and the addition of a category 2B designation for paclitaxel (Taxol)/carboplatin;
The addition of a category three designation for cisplatin/etoposide in concurrent chemotherapy/ RT followed by chemotherapy;
A recommendation to consider the use of erlotinib (Tarceva) with or without chemotherapy in advanced or metastatic NSCLC patients, “with known active epidermal growth factor receptor (EGFR) mutation and gene amplification,” who were never smokers.
“The regimens have been expanded and clarified by providing additional cisplatin-based regimens and chemotherapy regimens to use for patients with comorbidities or patients not able to tolerate cisplatin. These alternatives are mainly carboplatin-based regimens,” summarized Dr. Ettinger.
The latter update to the guidelines (recommending erlotinib utilization) is particularly notable because it “involves the use of molecular markers to individualize therapy for patients,” reported Dr. Ettinger. Commenting on the update, Dr. Ettinger stated, “the era of personalized medicine has come to lung cancer.”The Expanded Role of Chemotherapy