RESUMO
PURPOSE: To provide evidence-based recommendations updating the 2021 ASCO and Ontario Health (Cancer Care Ontario) guideline on systemic therapy for patients with stage IV non-small-cell lung cancer (NSCLC) with driver alterations. METHODS: ASCO updated recommendations on the basis of an ongoing systematic review of randomized control trials from 2020 to 2021. RESULTS: This guideline update reflects changes in evidence since the previous update. Two studies provide the evidence base. Outcomes of interest include efficacy and safety. RECOMMENDATIONS: For patients with an anaplastic lymphoma kinase rearrangement, a performance status (PS) of 0-2, and previously untreated NSCLC, clinicians should offer alectinib or brigatinib or lorlatinib. For patients with an anaplastic lymphoma kinase rearrangement, a PS of 0-2, and previously untreated NSCLC, if alectinib, brigatinib, or lorlatinib are not available, clinicians should offer ceritinib or crizotinib. For patients with a RET rearrangement, a PS of 0-2, and previously untreated NSCLC, clinicians may offer selpercatinib or pralsetinib. In second line, for patients with a RET rearrangement who have not received RET-targeted therapy, clinicians may offer selpercatinib or pralsetinib.Additional information is available at www.asco.org/thoracic-cancer-guidelines.
Assuntos
Carcinoma Pulmonar de Células não Pequenas , Neoplasias Pulmonares , Aminopiridinas , Quinase do Linfoma Anaplásico/genética , Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Carcinoma Pulmonar de Células não Pequenas/genética , Carcinoma Pulmonar de Células não Pequenas/patologia , Crizotinibe/uso terapêutico , Humanos , Lactamas , Neoplasias Pulmonares/tratamento farmacológico , Neoplasias Pulmonares/genética , Neoplasias Pulmonares/patologia , Compostos Organofosforados , Inibidores de Proteínas Quinases/uso terapêutico , Pirazóis , PirimidinasRESUMO
PURPOSE: To provide evidence-based recommendations updating the 2020 ASCO and Ontario Health (Cancer Care Ontario) guideline on systemic therapy for patients with stage IV non-small-cell lung cancer without driver alterations. METHODS: ASCO updated recommendations on the basis of an ongoing systematic review of randomized clinical trials from 2018 to 2021. RESULTS: This guideline update reflects changes in evidence since the previous update. Five randomized clinical trials provide the evidence base. Outcomes of interest include efficacy and safety. RECOMMENDATIONS: In addition to 2020 options for patients with high programmed death ligand-1 (PD-L1) expression (tumor proportion score [TPS] ≥ 50%), nonsquamous cell carcinoma (non-SCC), and performance status (PS) 0-1, clinicians may offer single-agent atezolizumab. With high PD-L1 expression (TPS ≥ 50%), non-SCC, and PS 0-1, clinicians may offer nivolumab and ipilumumab alone or nivolumab and ipilimumab plus chemotherapy. With negative (0%) and low positive PD-L1 expression (TPS 1%-49%), non-SCC, and PS 0-1, clinicians may offer nivolumab and ipilimumab alone or nivolumab and ipilimumab plus chemotherapy. With high PD-L1 expression, SCC, and PS 0-1, clinicians may offer single-agent atezolizumab. With high PD-L1 expression, squamous cell carcinoma (SCC), and PS 0-1, clinicians may offer nivolumab and ipilimumab alone or in combination with two cycles of platinum-based chemotherapy. With negative and low positive PD-L1 expression, SCC, and PS 0-1, clinicians may offer nivolumab and ipilimumab alone or in combination with two cycles of platinum-based chemotherapy. With non-SCC who received an immune checkpoint inhibitor and chemotherapy as first-line therapy, clinicians may offer second-line paclitaxel plus bevacizumab. With non-SCC, who received chemotherapy with or without bevacizumab and immune checkpoint inhibitor therapy, clinicians should offer the options of third-line single-agent pemetrexed, docetaxel, or paclitaxel plus bevacizumab.Additional information is available at www.asco.org/thoracic-cancer-guidelines.
Assuntos
Carcinoma Pulmonar de Células não Pequenas , Carcinoma de Células Escamosas , Neoplasias Pulmonares , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Antígeno B7-H1 , Bevacizumab/uso terapêutico , Carcinoma Pulmonar de Células não Pequenas/patologia , Carcinoma de Células Escamosas/tratamento farmacológico , Docetaxel/uso terapêutico , Humanos , Inibidores de Checkpoint Imunológico , Ipilimumab/uso terapêutico , Neoplasias Pulmonares/patologia , Nivolumabe/uso terapêutico , Paclitaxel/uso terapêutico , Pemetrexede/uso terapêuticoRESUMO
PURPOSE: To provide evidence-based recommendations updating the 2017 ASCO guideline on systemic therapy for patients with stage IV non-small-cell lung cancer (NSCLC) with driver alterations. A guideline update for systemic therapy for patients with stage IV NSCLC without driver alterations was published separately. METHODS: The American Society of Clinical Oncology and Ontario Health (Cancer Care Ontario) NSCLC Expert Panel updated recommendations based on a systematic review of randomized controlled trials (RCTs) from December 2015 to January 2020 and meeting abstracts from ASCO 2020. RESULTS: This guideline update reflects changes in evidence since the previous update. Twenty-seven RCTs, 26 observational studies, and one meta-analysis provide the evidence base (total 54). Outcomes of interest included efficacy and safety. Additional literature suggested by the Expert Panel is discussed. RECOMMENDATIONS: All patients with nonsquamous NSCLC should have the results of testing for potentially targetable mutations (alterations) before implementing therapy for advanced lung cancer, regardless of smoking status recommendations, when possible, following other existing high-quality testing guidelines. Most patients should receive targeted therapy for these alterations: Targeted therapies against ROS-1 fusions, BRAF V600e mutations, RET fusions, MET exon 14 skipping mutations, and NTRK fusions should be offered to patients, either as initial or second-line therapy when not given in the first-line setting. New or revised recommendations include the following: Osimertinib is the optimal first-line treatment for patients with activating epidermal growth factor receptor mutations (exon 19 deletion, exon 21 L858R, and exon 20 T790M); alectinib or brigatinib is the optimal first-line treatment for patients with anaplastic lymphoma kinase fusions. For the first time, to our knowledge, the guideline includes recommendations regarding RET, MET, and NTRK alterations. Chemotherapy is still an option at most stages.Additional information is available at www.asco.org/thoracic-cancer-guidelines.
Assuntos
Biomarcadores Tumorais/genética , Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Medicina Baseada em Evidências , Neoplasias Pulmonares/tratamento farmacológico , Mutação , Guias de Prática Clínica como Assunto/normas , Inibidores de Proteínas Quinases/uso terapêutico , Carcinoma Pulmonar de Células não Pequenas/genética , Carcinoma Pulmonar de Células não Pequenas/patologia , Humanos , Neoplasias Pulmonares/genética , Neoplasias Pulmonares/patologia , Prognóstico , Sociedades MédicasRESUMO
PURPOSE: The aim of this work is to provide evidence-based recommendations updating the 2017 ASCO guideline on systemic therapy for patients with stage IV non-small-cell lung cancer (NSCLC) without driver alterations. A guideline update for patients with stage IV NSCLC with driver alterations will be published separately. METHODS: The American Society of Clinical Oncology and Ontario Health (Cancer Care Ontario) NSCLC Expert Panel made updated recommendations based on a systematic review of randomized controlled trials from December 2015 to 2019. RESULTS: This guideline update reflects changes in evidence since the previous guideline update. Five randomized controlled trials provide the evidence base. Additional literature suggested by the Expert Panel is discussed. RECOMMENDATIONS: Recommendations apply to patients without driver alterations in epidermal growth factor receptor or ALK. For patients with high programmed death ligand 1 (PD-L1) expression (tumor proportion score [TPS] ≥ 50%) and non-squamous cell carcinoma (non-SCC), the Expert Panel recommends single-agent pembrolizumab. Additional treatment options include pembrolizumab/carboplatin/pemetrexed, atezolizumab/carboplatin/paclitaxel/bevacizumab, or atezolizumab/carboplatin/nab-paclitaxel. For most patients with non-SCC and either negative (0%) or low positive (1% to 49%) PD-L1, the Expert Panel recommends pembrolizumab/carboplatin/pemetrexed. Additional options are atezolizumab/carboplatin/nab-paclitaxel, atezolizumab/carboplatin/paclitaxel/bevacizumab, platinum-based two-drug combination chemotherapy, or non-platinum-based two-drug therapy. Single-agent pembrolizumab is an option for low positive PD-L1. For patients with high PD-L1 expression (TPS ≥ 50%) and SCC, the Expert Panel recommends single-agent pembrolizumab. An additional treatment option is pembrolizumab/carboplatin/(paclitaxel or nab-paclitaxel). For most patients with SCC and either negative (0%) or low positive PD-L1 (TPS 1% to 49%), the Expert Panel recommends pembrolizumab/carboplatin/(paclitaxel or nab-paclitaxel) or chemotherapy. Single-agent pembrolizumab is an option in select cases of low positive PD-L1. Recommendations are conditional on the basis of histology, PD-L1 status, and/or the presence or absence of contraindications. Additional information is available at www.asco.org/lung-cancer-guidelines.
Assuntos
Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Neoplasias Pulmonares/tratamento farmacológico , Feminino , Guias como Assunto , Humanos , Masculino , Estadiamento de NeoplasiasAssuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Transplante de Medula Óssea/métodos , Mieloma Múltiplo/diagnóstico , Mieloma Múltiplo/terapia , Terapia Combinada , Humanos , Hipercalcemia/etiologia , Hipercalcemia/terapia , Mieloma Múltiplo/complicações , Manejo da Dor/métodos , Cuidados Paliativos/métodos , PrognósticoAssuntos
Púrpura Trombocitopênica Trombótica/diagnóstico , Púrpura Trombocitopênica Trombótica/terapia , Anticorpos Monoclonais Murinos/uso terapêutico , Antineoplásicos/uso terapêutico , Gerenciamento Clínico , Humanos , Terapia de Imunossupressão/métodos , Imunoterapia/métodos , Troca Plasmática , Prognóstico , Púrpura Trombocitopênica Trombótica/epidemiologia , Fatores de Risco , Estados Unidos/epidemiologiaAssuntos
Leucemia Linfocítica Crônica de Células B/diagnóstico , Leucemia Linfocítica Crônica de Células B/terapia , Distribuição por Idade , Antineoplásicos/uso terapêutico , Linfócitos B/patologia , Biópsia por Agulha Fina , Medula Óssea/patologia , Deleção Cromossômica , Exposição Ambiental/efeitos adversos , Deleção de Genes , Predisposição Genética para Doença , Glomerulonefrite Membranoproliferativa/etiologia , Transplante de Células-Tronco Hematopoéticas , Hepatomegalia/etiologia , Humanos , Imunoglobulinas/sangue , Leucemia Linfocítica Crônica de Células B/epidemiologia , Leucemia Linfocítica Crônica de Células B/etiologia , Doenças Linfáticas/etiologia , Linfocitose/etiologia , Estadiamento de Neoplasias , Prognóstico , Proteínas Proto-Oncogênicas c-bcl-2/metabolismo , Grupos Raciais , Distribuição por Sexo , Dermatopatias Papuloescamosas/etiologia , Esplenectomia , Esplenomegalia/etiologia , Infecções Tumorais por Vírus/complicações , Conduta Expectante , Microglobulina beta-2/sangueAssuntos
Transtornos Mieloproliferativos/diagnóstico , Transtornos Mieloproliferativos/terapia , Antineoplásicos/uso terapêutico , Diagnóstico Diferencial , Feminino , Humanos , Janus Quinase 2/genética , Janus Quinases/antagonistas & inibidores , Mutação , Transtornos Mieloproliferativos/epidemiologia , Transtornos Mieloproliferativos/genética , Flebotomia , Inibidores da Agregação Plaquetária/uso terapêutico , Gravidez , Complicações Neoplásicas na Gravidez , Prognóstico , Medição de Risco , Transplante de Células-Tronco , Conduta ExpectanteAssuntos
Leucemia Mielogênica Crônica BCR-ABL Positiva/diagnóstico , Leucemia Mielogênica Crônica BCR-ABL Positiva/tratamento farmacológico , Benzamidas , Biópsia por Agulha Fina , Medula Óssea/patologia , Dasatinibe , Progressão da Doença , Feminino , Proteínas de Fusão bcr-abl/genética , Humanos , Mesilato de Imatinib , Leucemia Mielogênica Crônica BCR-ABL Positiva/epidemiologia , Leucemia Mielogênica Crônica BCR-ABL Positiva/genética , Leucocitose/etiologia , Cromossomo Filadélfia , Piperazinas/uso terapêutico , Contagem de Plaquetas , Gravidez , Complicações Neoplásicas na Gravidez , Atenção Primária à Saúde , Inibidores de Proteínas Quinases/uso terapêutico , Pirimidinas/uso terapêutico , Tiazóis/uso terapêutico , Translocação GenéticaAssuntos
Mieloma Múltiplo/diagnóstico , Mieloma Múltiplo/terapia , Agamaglobulinemia/etiologia , Amiloidose/etiologia , Anemia/etiologia , Antineoplásicos/uso terapêutico , Transplante de Células-Tronco Hematopoéticas , Humanos , Hipercalcemia/etiologia , Interleucina-6/sangue , Mieloma Múltiplo/etiologia , Mieloma Múltiplo/patologia , Proteínas do Mieloma/análise , Dor/etiologia , Paraparesia/etiologia , Plasmocitoma/etiologia , Prognóstico , Radiculopatia/etiologia , Insuficiência Renal/etiologia , Albumina SéricaAssuntos
Neoplasias Hematológicas/complicações , Hospedeiro Imunocomprometido , Anti-Infecciosos/uso terapêutico , Antibioticoprofilaxia , Antineoplásicos/efeitos adversos , Vacinas Bacterianas/administração & dosagem , Infecções Relacionadas a Cateter/etiologia , Cateterismo Venoso Central/efeitos adversos , Celulite (Flegmão)/etiologia , Celulite (Flegmão)/terapia , Diarreia/microbiologia , Encefalite/diagnóstico , Encefalite/tratamento farmacológico , Encefalite/etiologia , Endocardite Bacteriana/etiologia , Endocardite Bacteriana/terapia , Enterocolite Necrosante/etiologia , Enterocolite Necrosante/terapia , Humanos , Imunoglobulinas Intravenosas , Síndromes de Imunodeficiência/etiologia , Meningites Bacterianas/diagnóstico , Meningites Bacterianas/tratamento farmacológico , Meningites Bacterianas/etiologia , Neutropenia/etiologia , Pneumonia/diagnóstico , Pneumonia/tratamento farmacológico , Pneumonia/etiologia , Sexo Seguro , Pele/imunologia , Dermatopatias Infecciosas/etiologia , Dermatopatias Infecciosas/terapia , Esplenectomia , Subpopulações de Linfócitos T/imunologiaAssuntos
Anemia/diagnóstico , Anemia/etiologia , Técnicas de Laboratório Clínico , Feminino , Hemorragia/complicações , Humanos , Masculino , Anamnese , Exame FísicoAssuntos
Síndromes Mielodisplásicas , Fatores Etários , Idoso , Diagnóstico Diferencial , Humanos , Pessoa de Meia-Idade , Síndromes Mielodisplásicas/classificação , Síndromes Mielodisplásicas/diagnóstico , Síndromes Mielodisplásicas/tratamento farmacológico , Síndromes Mielodisplásicas/epidemiologia , Síndromes Mielodisplásicas/etiologia , Síndromes Mielodisplásicas/terapia , PrognósticoRESUMO
Improvements in delivery systems for enteral feeding, in formulas, and in the understanding of complications have made the technology for enteral feeding easy to apply. Adequate nutrients can be delivered, and individual tolerance for feeding is acceptable. The remaining question is when to apply the technology. Formula selection should be as simple as possible. Aspiration and other early complications are a serious risk and are not diminished by route of feeding. Long-term enteral feeding is associated with a high complication rate, with high mortality, and may not be effective.