Consistency of recommendations for the diagnosis and treatment of non-small cell lung cancer: a systematic review

Abstract

Background: To systematically assess the consistency of recommendations regarding diagnosis and treatment of non-small cell lung cancer (NSCLC) in clinical practice guidelines (CPGs).Methods: We systematically searched relevant literature databases and websites to identify CPGs related to NSCLC. We extracted the general characteristics of the included guidelines and their recommendations and descriptively compared and analyzed the consistency of recommendations across the guidelines.Results: A total of 28 NSCLC guidelines were retrieved. The recommendations covered mainly diagnosis and treatment. The recommendations in the guidelines differed substantially in various topics, such as the application of positron emission tomography (PET) and the classification of stage III. Fourteen guidelines divided stage III into two types: operable and inoperable; and the remaining 14 guidelines into three sub-stages IIIA, IIIB and IIIC. Recommendations regarding the treatment in stage III were relatively inconsistent. In driver gene (EGFR, ALK, ROS1) positive patients, targeted therapy was the most common recommendation for first-line treatment, but recommendations regarding second-line treatment varied according to the site of the mutation. In driver gene negative patients, immunotherapy was the most frequently recommended option as both first-and second-line treatment, followed by chemotherapy.Discussion: A number of countries are devoting themselves to develop NSCLC guidelines and the process of updating guidelines is accelerating, yet recommendations between guidelines are not consistent. We adopted a systematic review method to systematically search and analyze the NSCLC guidelines worldwide.We objectively reviewed the differences in recommendations for NSCLC diagnosis and treatment between the guidelines. Inconsistency of recommendations across guidelines can result from multiple potential reasons. Such as, the guidelines developed time, different countries and regions and many more. Poor consistency across CPGs can confuse the guideline users, and we therefore advocate paying more attention to examining the controversies and updating guidelines timely to improve the consistency among CPGs.Our study had also several limitations, we limited the search to CPGs published in Chinese or English, the interpretation of recommendations is inherently subjective, we did not evaluate the details of the clinical content of the CPG recommendations. Our research presents the current status of NSCLC guidelines worldwide and give the opportunity to pay more attention to the existing gaps. Further investigations should 2 Zhang et al. Consistency of NSCLC guidelines recommendations

Real-World Perspectives From Surgeons and Oncologists on Resectability Definition and Multidisciplinary Team Discussion of Stage III NSCLC in People’s Republic of China, Hong Kong, and Macau: A Physician Survey

“…The heterogeneity might also be related to the current lack of unified criteria for resectability and potential ambiguity in some areas of existing guidelines. 5,6 For example, a comparative analysis of simplified treatment decision criteria for stage III N2 NSCLC from various guidelines highlighted nonbulky multistation N2 disease as one area of greater variation in recommendations, 5 with around half recommending surgery-based approaches, and the rest indicating no preference or radiotherapy-based approaches. Similarly, in our survey, we observed minimal overall agreement between surgeons and oncologists on resectability of nonbulky multistation N2 with extensive nodal involvement (scenarios 11 and 12).…”

“…3,4 Appropriate selection of patients for multimodality approaches involving surgical resection presents notable challenges, partly owing to heterogeneity in guideline definitions and to the subjective and case-specific nature of determining potential resectability on the basis of preoperative assessments. [4][5][6] Moreover, with the rapidly evolving treatment landscape and emerging treatment options, the management of stage III NSCLC may become even more complex. Readouts from recent/ongoing trials incorporating targeted therapy or immunotherapy into neoadjuvant or adjuvant treatment combined with surgery suggest that some of these may represent future options for patients with operable NSCLC and actionable mutations.…”

Camrelizumab plus chemotherapy in advanced non‐squamous non‐small cell lung cancer: Treatment response, survival pattern, and safety

“…[6][7][8] Although the driver-gene-positive patients can benefit from specific targeted therapy, the driver-genenegative patients have limited treatment choices and unsatisfying survival as well. [9][10][11] In order to improve the prognosis of these patients, several immune checkpoint inhibitors (such as nivolumab, pembrolizumab, etc.) have been figured out to break the immune escape.…”

“…The treatment selections of NSCLC mostly depend on patients' clinical stage, in detail, patients at clinical stage I or II are usually surgical candidates, while clinical‐stage‐III patients often need the multidisciplinary discussion to make treatment choices (medical treatment, radiotherapy, or surgery, etc); besides, as to stage‐IV NSCLC patients, it is essential to analyse their driver genes (including epidermal growth factor receptor [EGFR], anaplastic lymphoma kinase [ALK], c‐ros oncogene 1 [ROS1]) for confirming the corresponding therapeutic regimens 6–8 . Although the driver‐gene‐positive patients can benefit from specific targeted therapy, the driver‐gene‐negative patients have limited treatment choices and unsatisfying survival as well 9–11 . In order to improve the prognosis of these patients, several immune checkpoint inhibitors (such as nivolumab, pembrolizumab, etc.)…”

Microarray Identifies a Key Carcinogenic Circular RNA 0008594 That Is Related to Non-Small-Cell Lung Cancer Development and Lymph Node Metastasis and Promotes NSCLC Progression by Regulating the miR-760-Mediated PI3K/AKT and MEK/ERK Pathways

“…As the most common type of lung cancer, non-small-cell lung cancer (NSCLC) accounts for approximately 85% of all cases (2,3). NSCLC treatment has been greatly promoted in recent years, benefiting from measures such as early screening programs, treatment strategy improvement, individualized and precise medicine, and novel targeted drug development (4)(5)(6)(7). In particular, along with the progression of molecular biotechnology, emerging treatment targets have been identified, and corresponding inhibitors have been developed, such as epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs), anaplastic lymphoma kinase (ALK) TKIs, and antiangiogenic drugs (8)(9)(10).…”