JTO Clinical and Research Reports (Jan 2021)
Japanese Lung Cancer Society Guidelines for Stage IV NSCLC With EGFR Mutations
- Kiichiro Ninomiya, MD, PhD,
- Shunsuke Teraoka, MD,
- Yoshitaka Zenke, MD, PhD,
- Hirotsugu Kenmotsu, MD, PhD,
- Yukiko Nakamura, MD,
- Yusuke Okuma, MD, PhD,
- Akihiro Tamiya, MD,
- Kaname Nosaki, MD,
- Masahiro Morise, MD, PhD,
- Keiju Aokage, MD,
- Yuko Oya, MD,
- Toshiyuki Kozuki, MD, PhD,
- Tomohiro Sakamoto, MD, PhD,
- Kentaro Tanaka, MD, PhD,
- Hisashi Tanaka, MD, PhD,
- Junko Tanizaki, MD, PhD,
- Satoru Miura, MD, PhD,
- Hideaki Mizutani, MD,
- Eisaku Miyauchi, MD, PhD,
- Ou Yamaguchi, MD, PhD,
- Noriyuki Ebi, MD,
- Yasushi Goto, MD, PhD,
- Takaaki Sasaki, MD, PhD,
- Haruko Daga, MD, PhD,
- Satoshi Morita, PhD,
- Takeharu Yamanaka, PhD,
- Shinsuke Amano, BCom,
- Kazuo Hasegawa, BFA,
- Chiyo K. Imamura, PhD,
- Kenichi Suzuki, PhD,
- Kazuko Nakajima, PhD,
- Hitomi Nishimoto, MN,
- Satoshi Oizumi, MD, PhD,
- Toyoaki Hida, MD, PhD,
- Katsuyuki Hotta, MD, PHD, MPH,
- Yuichi Takiguchi, MD, PhD
Affiliations
- Kiichiro Ninomiya, MD, PhD
- Department of Hematology, Oncology, and Respiratory Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
- Shunsuke Teraoka, MD
- Internal Medicine III, Wakayama Medical University, Wakayama, Japan
- Yoshitaka Zenke, MD, PhD
- Department of Thoracic Oncology, National Cancer Center Hospital East, Kashiwa, Japan
- Hirotsugu Kenmotsu, MD, PhD
- Division of Thoracic Oncology, Shizuoka Cancer Center, Shizuoka, Japan
- Yukiko Nakamura, MD
- Department of Respiratory Medicine, Yokohama Municipal Citizen’s Hospital, Yokohama, Japan
- Yusuke Okuma, MD, PhD
- Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan
- Akihiro Tamiya, MD
- Department of Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka, Japan
- Kaname Nosaki, MD
- Department of Thoracic Oncology, National Cancer Center Hospital East, Kashiwa, Japan
- Masahiro Morise, MD, PhD
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Keiju Aokage, MD
- Department of Thoracic Surgery, National Cancer Center Hospital East, Kashiwa, Japan
- Yuko Oya, MD
- Department of Thoracic Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
- Toshiyuki Kozuki, MD, PhD
- Department of Thoracic Oncology and Medicine, National Hospital Organization Shikoku Cancer Center, Matsuyama, Japan
- Tomohiro Sakamoto, MD, PhD
- Division of Respiratory Medicine and Rheumatology, Department of Multidisciplinary Internal Medicine, Tottori University, Tottori, Japan
- Kentaro Tanaka, MD, PhD
- Research Institute for Diseases of the Chest, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Hisashi Tanaka, MD, PhD
- Department of Respiratory Medicine, Hirosaki University Graduate School of Medicine, Aomori, Japan
- Junko Tanizaki, MD, PhD
- Department of Medical Oncology, Kishiwada City Hospital, Kishiwada, Japan
- Satoru Miura, MD, PhD
- Department of Internal Medicine, Niigata Cancer Center Hospital, Niigata, Japan
- Hideaki Mizutani, MD
- Department of Thoracic Oncology, Saitama Cancer Center, Saitama, Japan
- Eisaku Miyauchi, MD, PhD
- Department of Respiratory Medicine, Tohoku University Hospital, Sendai, Japan
- Ou Yamaguchi, MD, PhD
- Department of Respiratory Medicine, Comprehensive Cancer Center, Saitama Medical University International Medical Center, Saitama, Japan
- Noriyuki Ebi, MD
- Department of Respiratory Oncology, Iizuka Hospital, Fukuoka, Japan
- Yasushi Goto, MD, PhD
- Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan
- Takaaki Sasaki, MD, PhD
- Respiratory Center, Asahikawa Medical University, Asahikawa, Japan
- Haruko Daga, MD, PhD
- Department of Medical Oncology, Osaka City General Hospital, Osaka, Japan
- Satoshi Morita, PhD
- Department of Biomedical Statistics and Bioinformatics, Graduate School of Medicine Kyoto University, Kyoto, Japan
- Takeharu Yamanaka, PhD
- Department of Biostatistics, Yokohama City University School of Medicine, Yokohama, Japan
- Shinsuke Amano, BCom
- Japan Federation of Cancer Patient Groups, Yokohama, Japan
- Kazuo Hasegawa, BFA
- Japan Lung Cancer Alliance, Tokyo, Japan
- Chiyo K. Imamura, PhD
- Advanced Cancer Translational Research Institute, Showa University, Tokyo, Japan
- Kenichi Suzuki, PhD
- Division of Applied Pharmaceutical Education and Research, Hoshi University, Tokyo, Japan
- Kazuko Nakajima, PhD
- Department of Nursing and The Division of Stem Cell Transplantation, Shizuoka Cancer Center, Shizuoka, Japan
- Hitomi Nishimoto, MN
- Department of Nursing, Okayama University Hospital, Okayama, Japan
- Satoshi Oizumi, MD, PhD
- Department of Respiratory Medicine, National Hospital Organization Hokkaido Cancer Center, Sapporo, Hokkaido, Japan
- Toyoaki Hida, MD, PhD
- Department of Thoracic Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
- Katsuyuki Hotta, MD, PHD, MPH
- Center for Clinical Oncology, Okayama University Hospital, Okayama, Japan; Corresponding author. Address for correspondence: Katsuyuki Hotta, MD, PhD, MPH, Center for Innovative Clinical Medicine, Okayama University Hospital, 2-5-1, Shikata-cho, Okayama 700-8558, Japan.
- Yuichi Takiguchi, MD, PhD
- Department of Medical Oncology, Chiba University Hospital, Chiba, Japan
- Journal volume & issue
-
Vol. 2,
no. 1
p. 100107
Abstract
Patients with NSCLC in East Asia, including Japan, frequently contain EGFR mutations. In 2018, we published the latest full clinical practice guidelines on the basis of those provided by the Japanese Lung Cancer Society Guidelines Committee. The purpose of this study was to update those recommendations, especially for the treatment of metastatic or recurrent EGFR-mutated NSCLC. We conducted a literature search of systematic reviews of randomized controlled and nonrandomized trials published between 2018 and 2019 that multiple physicians had reviewed independently. On the basis of those studies and the advice from the Japanese Society of Lung Cancer Expert Panel, we developed updated guidelines according to the Grading of Recommendations, Assessment, Development, and Evaluation system. We also evaluated the benefits of overall and progression-free survival, end points, toxicities, and patients’ reported outcomes. For patients with NSCLC harboring EGFR-activating mutations, the use of EGFR tyrosine kinase inhibitors (EGFR TKIs), especially osimertinib, had the best recommendation as to first-line treatment. We also recommended the combination of EGFR TKI with other agents (platinum-based chemotherapy or antiangiogenic agents); however, it can lead to toxicity. In the presence of EGFR uncommon mutations, except for an exon 20 insertion, we also recommended the EGFR TKI treatment. However, we could not provide recommendations for the treatment of EGFR mutations with immune checkpoint inhibitors, including monotherapy, and its combination with cytotoxic chemotherapy, because of the limited evidence present in the literature. The 2020 Japanese Lung Cancer Society Guidelines can help community-based physicians to determine the most appropriate treatments and adequately provide medical care to their patients.
