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ASCO Updates Stage IV NSCLC Treatment Guideline
J Clin Oncol; ePub 2017 Aug 14; Hanna, et al
ASCO has updated its guideline on systemic therapy for stage IV non-small-cell lung cancer (NSCLC).
Regarding first-line treatment of non-squamous cell carcinoma (SCC) or SCC (without positive markers), if the patient has:
- High programmed death ligand 1 (PD-L1) expression, use pembrolizumab alone.
- Low PD-L1 expression, offer standard chemotherapy.
Regarding second-line treatment in patients who received first-line chemotherapy without prior immune checkpoint therapy, if the tumor:
- Is positive for PD-L1 expression, use single-agent nivolumab, pembrolizumab, or atezolizumab.
- Has negative or unknown PD-L1 expression, use nivolumab or atezolizumab.
For patients:
- Who received a prior first-line immune checkpoint inhibitor, offer standard chemotherapy.
- Who cannot receive immune checkpoint inhibitor after chemotherapy, use docetaxel.
- With nonsquamous NSCLC, use pemetrexed.
- With a sensitizing epidermal growth factor receptor (EGFR) mutation, disease progression after first-line EGFR tyrosine kinase inhibitor therapy, and T790M mutation, use osimertinib (or chemotherapy in absence of T790M mutation).
- With ROS1 gene rearrangement, offer crizotinib if it was not used previously, or chemotherapy if it was.
Citation:
Hanna N, Johnson D, Temin S, et al. Systemic therapy for stage IV non-small-cell lung cancer: American Society of Clinical Oncology clinical practice guideline update. [Published online ahead of print August 14, 2017]. J Clin Oncol. doi:10.1200/JCO.2017.74.6065.