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ESMO's guidelines for the clinical management of Early Stage and Locally Advanced Non-Small Cell Lung Cancer have recently been released (August 28, 2025 In annals of Oncology journal).

In the USA, two major scientific societies are legitimate to issue clinical guidelines for the clinicla management of cancer patients, in order to represnent the American perspectives on that disease: the National Comprehensive Cancer Network (NCCN) and American Society of Clinical Oncology (ASCO).

USA: key distinctions between NCCN vs ASCO:
While both organizations develop influential guidelines, they serve different roles in the American healthcare landscape:

NCCN Characteristics:

1. Comprehensive coverage: NCCN provides stage-specific guidelines covering the entire patient journey from screening through survivorship
2. Rapid updates: NCCN prioritizes speed in incorporating new evidence and FDA approvals
3. Broader treatment options: Offers a wider range of therapy choices for each line of treatment
4. Consensus-driven approach: NCCN opinions is based on expert consensus from leading cancer centers
5. Insurance impact: Guidelines are directly used by both public and private insurers to determine cancer drug coverage

ASCO Characteristics:

1. Focused approach: ASCO guidelines typically address specific clinical questions rather than comprehensive disease management
2. Rigorous methodology: Emphasizes systematic literature reviews over narrative reviews
3. Living guidelines: Maintains continuously updated guidelines for rapidly evolving areas like stage IV NSCLC
4. Evidence grading: Uses explicit evidence quality ratings and recommendation strengths

The management of early stage and locally advanced non-small cell lung cancer has undergone significant transformation with the introduction of immunotherapy, targeted therapies, and personalized medicine approaches. Across the Atlantic, three major oncology organizations provide influential clinical practice guidelines that shape worldwide NSCLC management: and the European Society for Medical Oncology (ESMO) providing European recommendations.

These three scientific societies guidelines serve different purposes and employ distinct methodologies, resulting in meaningful variations in their recommendations for diagnosis, staging, treatment selection, and follow-up protocols. The understanding of these differences is crucial for clinicians working in international settings, participating in clinical trials, or treating diverse patient populations. Additionally, the understanding of these recommendations are impactful in terms of market access and pricing of anti-cancer treatments, because they rule local HTA agencies for the coverage of these therapeutic agents.

Major Research Findings between USA and Europe's guidelines

1. Revolutionary Perioperative Treatment Integration: The 2025 guidelines across all organizations show unprecedented convergence on perioperative immunotherapy, with CheckMate 816 demonstrating significant 5-year overall survival benefit (65% vs 55%) for neoadjuvant nivolumab plus chemotherapy. The NeoADAURA trial results presented at ASCO 2025 further validate targeted therapy integration in the perioperative setting.[1][2][3]
2. Expanded Biomarker Testing Requirements: The analysis reveals significant expansion in biomarker testing, with ESMO 2025 requiring 12 actionable biomarkers, NCCN recommending 14+ biomarkers universally, and ASCO maintaining evidence-focused selective testing. Notably, biomarker testing rates before first-line therapy reached only 45% for NSCLC patients despite guideline recommendations.[4][5][6]
3. An evolution of the methodology: The guidelines show distinct methodological approaches - NCCN prioritizes rapid consensus-driven updates, ASCO emphasizes rigorous systematic reviews with living guidelines, while ESMO 2025 introduces enhanced MCBS Version 1.2 for treatment value assessment with integrated cost-effectiveness analysis.[7][8]
4. Healthcare System Integration Differences: Critical variations exist in treatment access patterns, with FDA approvals integrated 6-12 months faster than EMA approvals, creating significant international disparities in novel therapy accessibility. The ESMO MCBS framework provides systematic cost-effectiveness assessment, which medico-economic framework is missing from American guidelines.[9][4]

Key Clinical Practice Implications
The research demonstrates that while core treatment principles align globally, significant differences are to be found in:
[ol]

This comprehensive analysis provides healthcare professionals with essential insights for navigating the complex international landscape of NSCLC clinical guidelines, enabling optimal patient care decisions across different healthcare systems while understanding the regulatory, economic, and methodological factors that drive practice variations and their practical local consequences for treatment availability and prices.

Guidelines in practice

• ESMO Clinical Practice Guideline: Early Stage and Locally Advanced Non-Small Cell Lung Cancer esmo.org/guidelines/esmo-clini…
• NCCN guidelines for healthcare professionals (with subscription) nccn.org/guidelines/guidelines… (Version 8.2025)
• Although there is no real ASCO guideline for the management of early stage to locally advanced NSCLC indication, ASCO provides guideline for the management of this disease in resected state: "Adjuvant Systemic Therapy and Adjuvant Radiation Therapy for Stage I to IIIA Completely Resected Non–Small-Cell Lung Cancers" is ASCO's main and latest guideline addressing early stage NSCLC. One needs to mention the range of this guideline may not overlap exactly the range of NCCN and ESMO. https://ascopubs.org/doi/10.1200/JCO.2017.72.4401

#nsclc #ESMO #lungcancer #cancer #guidelines #healthcare #clinical #guideline #clinicalpractice #cancertreatment #personalizedmedicine #precisiononcology

References
1. esmo.org/oncology-news/neoadju…
2. dailyreporter.esmo.org/opinion…
3. esmo.org/oncology-news/neoadju…
4. pmc.ncbi.nlm.nih.gov/articles/…
5. thelancet.com/journals/lanepe/…
6. jamanetwork.com/journals/jaman…
7. guidelinecentral.com/insights/…
8. guidelinecentral.com/insights/…
9. casopisvnitrnilekarstvi.cz/en/…

We have previously published a structured summary of ESMO's recommendations for the management of non-small cell lung cancer (NSCLC), which have evolved considerably this year, marking a major turning point in the perioperative therapeutic approach. The most significant changes of these new guidelines focus on the integration of immunotherapy in neoadjuvant and adjuvant strategies.

Evolution Towards Perioperative Immunotherapy
New Recommendations for Neoadjuvant Immunotherapy
New 2025 guidelines mark the definitive adoption of immunotherapy in combination with chemotherapy in neoadjuvant treatment. This evolution is based on compelling results from several pivotal studies:[1]
[2]

1. - CheckMate 816: The combination of nivolumab plus platinum-based chemotherapy demonstrated a significant progression-free survival benefit (HR 0.63) and final overall survival (HR 0.72) [3][4]
2. - KEYNOTE-671: Perioperative pembrolizumab showed improved event-free survival with an HR of 0.57 and overall survival benefit[5][6]

Changes in Eligibility Criteria
Unlike previous recommendations that limited neoadjuvant immunotherapy to patients with PD-L1 ≥1%, the new 2025 guidelines extend this approach to all eligible patients, including those with PD-L1 <1%. This extension is supported by recent meta-analyses demonstrating an event-free survival benefit even in this subpopulation (HR 0.74).[7]
[8]Evolution of Adjuvant Targeted Therapies
Expansion of Osimertinib Indications
The 2025 recommendations consolidate and extend the use of adjuvant osimertinib for patients with EGFR mutations. New data from the ADAURA study show: [9]
[10]

1. - 4-year disease-free survival benefit of 73% versus 38% with placebo
2. - 73% reduction in recurrence risk (HR 0.27) [10]

An important new indication has been approved for osimertinib in unresectable locally advanced (stage III) cancer after chemoradiotherapy, with a remarkable progression-free survival benefit (39.1 months versus 5.6 months). [11]

[12]Changes in Diagnostic Approach and Biomarkers
The Strengthening of Molecular Testing
The 2025 guidelines place greater emphasis on the importance of comprehensive molecular testing before treatment initiation, particularly in never-smokers where the frequency of targetable alterations is very high (EGFR 52%, ALK 8%).

[13]Integration of Liquid Biopsy
Despite suboptimal sensitivity in current assays, with a large proportion of false-negative results in patients that subsequently experience recurrence. ESMO gives a conclusion that currently available assays are prognostic but not predictive of treatment outcomes and cannot be used for treatment de-escalation after curative-intent therapy at this time. Further technological advances are needed before clinical implementation. Finally, the use of circulating tumor DNA is now better integrated into recommendations, particularly for resistance detection and therapeutic monitoring. [14]

[10]Noteworthy, ESMO's 2025 guidelines seamlessly align with major liquid biopsy programs across Europe, integrating ctDNA testing into routine NSCLC care.
The NHS leads globally with its "blood test–first" model, offering liquid biopsies to 15,000 lung cancer patients annually and reducing turnaround by two weeks. France’s Plan Médecine Génomique 2025 invested €239 million, enabling in-house testing via FoundationOne Liquid CDx at Gustave Roussy. Germany’s robust reimbursement framework underpins a $940.9 million market in 2024, projected to $1.75 billion by 2030. Spain’s Vall d’Hebron Institute hosts Europe’s first Guardant Health service, while Italy’s GerSom initiative offers combined somatic/germline profiling of 467 genes. The European Liquid Biopsy Society (93 institutions in 21 countries) standardizes implementation and tackles IVDR compliance and reimbursement. A $1.24 billion European market in 2024, forecast to $5.58 billion by 2033, provides the commercial foundation supporting these clinical efforts. One can easily picture that the integration of liquid biopsies in the guidelines will have strong consequences in terms of common law coverage of this molecular screening technique in Europe.

Changes in Treatment Stratification
New Therapeutic Hierarchy
The 2025 recommendations establish a clear hierarchy of approaches:

1. Patients with EGFR mutations: Adjuvant osimertinib remains the standard for resectable stages IB-IIIA
2. Patients without targetable mutations: Neoadjuvant chemoimmunotherapy becomes the preferred approach for stages II-IIIA
3. Perioperative approach: Preference for neoadjuvant chemoimmunotherapy followed by adjuvant immunotherapy.

Different Regional Regulatoy Approaches
The 2025 recommendations reflect approval disparities between the EMA and FDA. While the FDA approves neoadjuvant immunotherapy for all eligible patients, the EMA maintains a restriction to patients with PD-L1 ≥1%, creating access differences in Europe. [8][3]

[7]Impact on Clinical Management
New Practical Considerations
The 2025 guidelines integrate new practical considerations:

1. - Assessment of pathological response as an important endpoint (MPR and pCR)
2. - Management of perioperative immunological toxicities
3. - Importance of surgical timing after neoadjuvant chemoimmunotherapy
4. - Post-operative surveillance adapted to new treatments

Considering treatment duration and sequencing, the new recommendations specify the following optimal durations:

1. - 3-4 cycles of neoadjuvant before surgery
2. - Continuation of adjuvant immunotherapy up to 1 year after surgery
3. - Need for multidisciplinary evaluation to optimize sequencing [15][5]

These developments represent a major paradigm shift towards a personalized approach that systematically integrates biomarkers and prioritizes perioperative strategies to improve outcomes for patients with early-stage and locally advanced NSCLC.

esmo.org/guidelines/esmo-clini…

#nsclc #ESMO #lungcancer #cancer #guidelines #healthcare #clinical #guideline #clinicalpractice #cancertreatment #personalizedmedicine #precisiononcology

References

1. oncodaily.com/societies/clinic…
2. pubmed.ncbi.nlm.nih.gov/405711…
3. esmo.org/oncology-news/periope…
4. esmo.org/oncology-news/neoadju…
5. dailyreporter.esmo.org/esmo-im…
6. esmo.org/guidelines/esmo-mcbs/…
7. esmo.org/oncology-news/neoadju…
8. jamanetwork.com/journals/jamao…
9. esmo.org/guidelines/esmo-mcbs/…
10. esmo.org/oncology-news/final-d…
11. esmo.org/oncology-news/ema-rec…
12. esmo.org/oncology-news/osimert…
13. ressources-aura.fr/wp-content/…
14. esmo.org/meeting-calendar/past…
15. dailyreporter.esmo.org/opinion…

n816 Life

2025-08-28 14:05:21

A structured Summary of ESMO's Clinical Practice Guidelines for Early Stage and Locally Advanced Non-Small Cell Lung Cancer (NSCLC)

Title: Early and locally advanced non-small-cell lung cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up

Publication Date: August 28, 2025 – Annals of Oncology
Authors: Zer A, Ahn MJ, Barlesi F, et al., on behalf of the ESMO Guidelines Committee.

Published in Annals of Oncology on August 28, 2025, new ESMO guidelines represent a critical resource for clinicians navigating the complexities of diagnosis, treatment, and long-term management of this challenging disease. Developed by a multidisciplinary team of global experts, these guidelines integrate the latest scientific evidence with consensus-based recommendations to ensure standardized, high-quality care. By offering clear treatment algorithms for both resectable and unresectable cases, they aim to improve outcomes and guide clinical decision-making in NSCLC.

Guideline Objectives

Target Audience: Healthcare professionals managing early stage and locally advanced non-small cell lung cancer (NSCLC).

Scope:

Diagnosis and staging of the disease.
Risk assessment to tailor management.
Treatment recommendations, including therapeutic algorithms for resectable and unresectable cases.
Follow-up protocols for patients post-treatment.

Key Features

Treatment Algorithms: Provided to guide therapeutic decisions for resectable and unresectable disease.
Comprehensive Approach: Covers diagnosis, treatment, and follow-up to optimize patient care.

esmo.org/guidelines/esmo-clini…

#nsclc #ESMO #lungcancer #cancer #guidelines #healthcare #clinical #guideline #clinicalpractice #cancertreatment

Guideline Objectives

Target Audience: Healthcare professionals managing early stage and locally advanced non-small cell lung cancer (NSCLC).

Scope:

Diagnosis and staging of the disease.
Risk assessment to tailor management.
Treatment recommendations, including therapeutic algorithms for resectable and unresectable cases.
Follow-up protocols for patients post-treatment.

Key Features

Treatment Algorithms: Provided to guide therapeutic decisions for resectable and unresectable disease.
Comprehensive Approach: Covers diagnosis, treatment, and follow-up to optimize patient care.

esmo.org/guidelines/esmo-clini…

#nsclc #ESMO #lungcancer #cancer #guidelines #healthcare #clinical #guideline #clinicalpractice #cancertreatment

makertube.net/w/ot8N86yQ5qpFDA…

n816 Life

2025-07-02 16:55:56

Comment évaluer le bruit des éoliennes en situation ?

[Fr] Le champ d'éoliennes du mont Tauch (Corbières, entre Tuchan et Padern, aude, France) nous a servi pour une évaluation suggestive du bruit des éoliennes immédiatement en dessous, par très fort vent en haut (force 7 ou 8). On remarque en conclusion, que l'éolienne n'engendre aucun surbruit par rapport à celui engendré par le vent lui même. Il n'y a pas de nuisances sonores causées par un champ d'éoliennes, et les chevaux ne s'y trompent pas, et s'installent spontanément juste au dessous.

Retrouvez la [version Spotify] de cette video ici: open.spotify.com/episode/5l7o0…
Remerciements pour les musiques:
⁠⁠⁠Icons8.com ⁠⁠⁠⁠⁠⁠
icons8.com/music/track/rock-gu… ⁠⁠⁠⁠⁠⁠⁠⁠
icons8.com/music/track/rock-in… ⁠

makertube.net/w/uDXjquXa2N8AGG…

n816 Life

2025-07-03 16:48:26

How can wind turbine noise be assessed in real-life situations?

[En] The wind farm on Mount Tauch (Corbières, between Tuchan and Padern, Aude, France) was used for a suggestive assessment of the noise generated by the wind turbines immediately below, in very strong winds at the top (force 7 or 8). In conclusion, we note that the wind turbine does not generate any additional noise compared to that generated by the wind itself. There is no noise pollution caused by a wind farm, and horses are not fooled by this, settling spontaneously just below it.

Find the [Spotify version] of this video here: open.spotify.com/episode/1CNKC…
Credits for the music:
⁠⁠⁠Icons8.com ⁠⁠⁠⁠⁠⁠
icons8.com/music/track/rock-gu… ⁠⁠⁠⁠⁠⁠⁠⁠
icons8.com/music/track/rock-in… ⁠