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Vol.61 No.3 contents | Japanese/English |
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- Invited Review Article -
The 2020 Edition of the Clinical Guidelines for Lung Cancer: Challenges and Future Perspectives
Yuichi Takiguchi1, Takashi Seto2, Kaname Nosaki3, Kazuo Hasegawa4, Satoshi Morita5, Ryo Morita6, Kiichiro Ninomiya7, Toyoaki Hida81Department of Medical Oncology, Graduate School of Medicine, Chiba University, Japan, 2Department of Thoracic Oncology, National Hospital Organization Kyushu Cancer Center, Japan, 3Department of Thoracic Oncology, National Cancer Center Hospital East, Japan, 4NPO Lung Cancer Patients Network One Step, Japan, 5Department of Biomedical Statistics and Bioinformatics, Kyoto University Graduate School of Medicine, Japan, 6Department of Respiratory Medicine, Akita Kousei Medical Center, Japan, 7Department of Hematology, Oncology and Respiratory Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan, 8Department of Thoracic Oncology, Aichi Cancer Center, Japan
Objective. To improve the clinical guidelines for lung cancer. Methods. By focusing on the discussion topics at a symposium held in the annual meeting of the Japan Lung Cancer Society 2020 and the results of two independent external evaluations of the guidelines, the history, advantages and limitations of the guidelines were reviewed with respect to problems to be solved. Results. The guidelines were established in 2003 and have been updated annually since 2011. Their contemporary and scientific validity are highly evaluated by external evaluations, whereas the constitutive framework has found to be lacking in many aspects. Rapid advancement in molecular target therapy and therapy with immune checkpoint inhibitors has forced changes in the methodology of clinical trials and in statistical interpretation, resulting in multiple recommendations for a certain specific disease condition. It is important to address the wide diversity of values used for the evaluation of therapeutic outcomes. Conclusion. Problems include heterogeneity in clinical trials, the methodology of interpretation and individual values. Although various medical staff, biostatisticians and patients were already involved in the process of preparing the guidelines, much wider discussion among various stakeholders should be undertaken to solve these problems and improvements that reflect external evaluation should be implemented.
key words: Lung cancer, Clinical guideline, GRADE system, External evaluation, Biostatistics
JJLC 61 (3): 163-170, 2021
