NCCN临床实践指南_恶性胸膜间皮瘤(2019.V2)英文版

NCCN org NCCN Guidelines for Patients available at www nccn org patients Version 2 2019 04 01 19 2019 National Comprehensive Cancer Network NCCN All rights reserved NCCN Guidelines and this illustration may not be reproduced in any form without the express written permission of NCCN NCCN Clinical Practice Guidelines in Oncology NCCN Guidelines Malignant Pleural Mesothelioma Version 2 2019 April 1 2019 Continue NCCN Guidelines Panel Disclosures Continue Diagnostic Interventional radiology Hematology Hematology oncology Internal medicine Medical oncology Pathology Radiation oncology Radiotherapy Surgery Surgical oncology Discussion Section Writing Committee David S Ettinger MD Chair The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Douglas E Wood MD Vice Chair Fred Hutchinson Cancer Research Center Seattle Cancer Care Alliance Dara L Aisner MD PhD University of Colorado Cancer Center Wallace Akerley MD Huntsman Cancer Institute at the University of Utah Jessica Bauman MD Fox Chase Cancer Center Ankit Bharat MD Robert H Lurie Comprehensive Cancer Center of Northwestern University Debora Bruno MD Case Comprehensive Cancer Center University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute Joe Y Chang MD PhD The University of Texas MD Anderson Cancer Center Lucian R Chirieac MD Dana Farber Brigham and Women s Cancer Center Thomas A D Amico MD Duke Cancer Institute Thomas J Dilling MD MS Moffitt Cancer Center Michael Dobelbower MD PhD University of Alabama at Birmingham Comprehensive Cancer Center Ramaswamy Govindan MD Siteman Cancer Center at Barnes Jewish Hospital and Washington University School of Medicine Matthew A Gubens MD MS UCSF Helen Diller Family Comprehensive Cancer Center Mark Hennon MD Roswell Park Cancer Institute Leora Horn MD MSc Vanderbilt Ingram Cancer Center Rudy P Lackner MD Fred Surgical Evaluation MPM 2 Clinical Stage IIIB or IV or Medically Inoperable Treatment MPM 2 Clinical Stage I IIIA Treatment for Epithelial Histology or Sarcomatoid or Mixed Histology MPM 3 Principles of Systemic Therapy MPM A Principles of Supportive Care MPM B Principles of Surgery MPM C Principles of Radiation Therapy MPM D Staging ST 1 The NCCN Guidelines are a statement of evidence and consensus of the authors regarding their views of currently accepted approaches to treatment Any clinician seeking to apply or consult the NCCN Guidelines is expected to use independent medical judgment in the context of individual clinical circumstances to determine any patient s care or treatment The National Comprehensive Cancer Network NCCN makes no representations or warranties of any kind regarding their content use or application and disclaims any responsibility for their application or use in any way The NCCN Guidelines are copyrighted by National Comprehensive Cancer Network All rights reserved The NCCN Guidelines and the illustrations herein may not be reproduced in any form without the express written permission of NCCN 2019 NCCN Guidelines Version 2 2019 Malignant Pleural Mesothelioma Version 2 2019 04 01 19 2019 National Comprehensive Cancer Network NCCN All rights reserved NCCN Guidelines and this illustration may not be reproduced in any form without the express written permission of NCCN NCCN Guidelines Index Table of Contents Discussion Printed by Maria Chen on 4 8 2019 10 30 33 PM For personal use only Not approved for distribution Copyright 2019 National Comprehensive Cancer Network Inc All Rights Reserved UPDATES MPM 1 Initial Evaluation bullet 3 minimize number of ports added to end of statement MPM 2 Clinical Assessment Top pathway was modified Clinical stage I IIIA and Epithelial histology or Sarcomatoid or Mixed histology Bottom pathway was modified Clinical stage IIIB or IV or Sarcomatoid or Mixed histology or Medically inoperable Treatment Pathway for PS 0 2 was modified Consider observation for progression or Chemotherapy Consider observation now leads to Progression which leads to Chemotherapy Footnote c was added Surgery should be considered for sarcomatoid or mixed histology if the patient has early stage disease and in the case of sarcomatoid responds to induction therapy Also added to MPM 3 Footnote f was modified PET CT should be performed before any pleurodesis if practical If PET CT is to be done recommend obtaining PET CT before pleurodesis Confirm diagnosis of MPM prior to pleurodesis If MPM is suspected consider evaluation by a multidisciplinary team with expertise in MPM MPM 3 Clinical Stage was modified Clinical stage I IIIA and Epithelial histology or Sarcomatoid or Mixed histology Adjuvant Treatment fourth pathway was modified Chemotherapy followed by observation or Consider RT RT optional All pathways are now directed to Progression to lead the reader to the Principles of Systemic Therapy MPM A after Adjuvant Treatment MPM A 1 of 2 Subsequent Systemic Therapy Nivolumab ipilimumab category changed from a category 2B to a category 2A MPM B First bulle