What's Hot at NCCN 2012

March 8, 2012 ? The benefits and practicalities of lung cancer screening and the use of newly approved drugs for metastatic melanoma are among the notable topics at the National Comprehensive Cancer Network (NCCN) 17th Annual Conference, being held March 14 to 18 in Hollywood, Florida.

The NCCN made headlines last year by strongly recommending the use of low-dose helical computed tomography (CT) screening for select individuals at high risk for lung cancer.丽水市人民医院血液科曲志刚

"This is really big," said Mary Reid, PhD, associate professor of oncology at Roswell Park Cancer Institute in Buffalo, New York, about the potential of lung cancer screening to reduce lung cancer deaths.

In 2011, the landmark National Lung Screening Trial (NLST) found a 20% reduction in deaths from lung cancer among current and former heavy smokers screened with CT, compared with those screened with chest radiograph.

Dr. Reid will be 1 of 3 experts who will make a presentation on lung cancer screening at the meeting. In an interview with Medscape Medical News, she said that she expects skepticism from clinicians in the audience. Incorporating screening into clinical practice "will require big changes in how these patients are managed," she said.

This year"s meeting will have sessions that will update NCCN guidelines for advanced renal cell carcinoma, breast cancer, colorectal cancer, acute lymphoblastic leukemia, nonsmall-cell lung cancer, multiple myeloma, non-Hodgkin"s lymphoma, prostate cancer, and ovarian cancer.

Other sessions will address central nervous system metastases, treating adolescent and young adults, and cancer survivorship.

The meeting will feature, for the seventh consecutive year, a roundtable discussion led by veteran ABC News journalist Sam Donaldson, who is a cancer survivor. This year"s topic is "Cancer and Corporate America: Business as Usual?"

The roundtable kicks off the conference and is one of the hallmarks of the annual event; it brings together an eclectic group of people to discuss a cancer topic, sometimes in a highly personal way. The participants this year include John S. Greene, director of engineering at Salesforce.com and a cancer survivor; J. Randall MacDonald, senior vice president of human resources at IBM; Sheri S. McCoy, MSc, MBA, vice chair of the executive committee at Johnson & Johnson; and J. Brent Pawlecki, MD, chief health officer at Goodyear Tire & Rubber Company.

The meeting will also feature a review of the clinical practice guidelines for melanoma.

This session promises to be full of details about the efficacy and adverse events associated with the 2 therapies for advanced disease approved in 2011 by the US Food and Drug Administration. The immunotherapy ipilimumab (Yervoy, Bristol-Myers Squibb) was the first agent ever proven to improve survival in advanced melanoma. The oral targeted therapy vemurafenib (Zelboraf, Plexxikon/Roche) is specifically indicated for patients with melanoma whose tumors have V600E mutations in the BRAF gene. An estimated 50% of patients with melanoma have this type of BRAF mutation, which does not occur in normal cells.

More on Lung Cancer Screening

In November 2011, the NCCN became the first national advisory group to publish guidelines on the use of CT screening for select individuals at high risk for the disease. For the target group of heavy smokers 55 to 74 years of age, regular annual CT scans are recommended.

This is a category 1 recommendation, which is based on high-level evidence (i.e., a randomized controlled trial) and uniform NCCN consensus that the intervention is appropriate.

"The evidence is really strong," said Dr. Reid.

The magnitude of the mortality benefit from lung cancer screening with CT is "better than what you get with PSA testing and mammography," she said. And the benefit approaches that seen with colonoscopy, she added.

These high-risk individuals are defined as adults 55 to 74 years of age with a 30-pack-year or more history of smoking tobacco (i.e., smoking 1 pack a day for 30 years), even if they stopped smoking within the past 15 years.

This is the same as the inclusion criteria for the NLST, which was halted early last year after showing a significant lung-cancer-specific mortality benefit.

The NCCN guidelines recommend regular CT screening for another group of high-risk individuals ? those who are slightly less-heavy smokers (a 20-pack-year or more history of smoking) but who have an additional risk factor, such as cancer history, lung disease history, family history of lung cancer, radon exposure, and occupational exposure. This is a category 2B recommendation for low-dose CT screening. It is based on lower-level evidence and NCCN consensus, but not uniform consensus (as in category 2A), which signifies that there was some debate about this recommendation.

There are a number of challenges and controversies regarding the use of CT screening in this setting, said Dr. Reid.

One of the difficulties with the screening is its high rate of false positives. "You pick up a lot of nodules that are not cancer. Ninety-six percent of the nodules found in the NLST were not cancer," she pointed out.

In the case of a found nodule, a patient must undergo either follow-up for 3 to 6 months or an interventional procedure for tissue analysis. "It"s not trivial," she said about the ramifications of a found nodule.

This guideline will require a lot of work.

"The process of following this guideline will require a lot of work," she summarized.

At the NCCN meeting, Dr. Reid will present some case studies of patients from Roswell Park, which has been running a lung cancer screening program since 1998. The unusual program has the backing of local payors, who saw the potential for cost savings in detecting lung cancer early, she said. Dr. Reid has 10-year data on patients who have undergone screening, and will share some with the NCCN audience.

The Roswell Park program has been affected by the publicity surrounding the NLST. It seems that the message about the mortality benefit has penetrated the consciousness of residents of upstate New York, who have been side-stepping their doctors in some cases. "Lately, there has been an upsurge in people self-referring into the program," she said.