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10-02-2020 | Oncology | News | Article

guidelinesWatch        

ASCO/Ontario Health update released for stage IV NSCLC without driver alterations

Author:
Lynda Williams

medwireNews: Updated guidelines for the care of patients with stage IV non-small-cell lung cancer (NSCLC) without driver alterations in EGFR or ALK have been released by an expert panel of ASCO and Ontario Health oncologists.

The latest recommendations describe changes to first-line treatment that are based on data from five phase 3 trials reported in 2018 and 2019, namely KEYNOTE-042, KEYNOTE-189, IMpower 150, IMpower 130, and KEYNOTE-047.

For patients with nonsquamous cell carcinoma and a high PD-L1 expression, defined as a tumor proportion score (TPS) of 50% or above, and an ECOG performance status (PS) of 0 or 1, the recommended treatment options in order of preference are:

  • Single-agent pembrolizumab;
  • Pembrolizumab with carboplatin and pemetrexed;
  • Atezolizumab with carboplatin, paclitaxel, and bevacizumab;
  • Atezolizumab, carboplatin, and nab-paclitaxel.

For nonsquamous cell carcinoma patients with no (TPS 0%) or low (TPS 1–49%) PD-L1 expression and a PS of 0 or 1, the order of preferred treatments is:

  • Pembrolizumab, carboplatin, and pemetrexed;
  • Atezolizumab, carboplatin, paclitaxel, and bevacizumab;
  • Atezolizumab, carboplatin, and nab-paclitaxel;
  • Platinum-based doublet chemotherapy;
  • Non-platinum-based doublet chemotherapy;
  • Single-agent pembrolizumab.

For patients with squamous cell carcinoma, a high PD-L1 expression, and a PS of 0–1, the recommendations in order of preference are:

  • Single-agent pembrolizumab;
  • Pembrolizumab, carboplatin, and paclitaxel or nab-paclitaxel.

For patients with squamous cell carcinoma, no or low PD-L1 expression, and a PS of 0–1, the recommendations in order of preference are:

  • Pembrolizumab, carboplatin, and paclitaxel or nab-paclitaxel;
  • Platinum-based doublet chemotherapy;
  • Non-platinum-based double chemotherapy;
  • Single-agent pembrolizumab.

Recommendations for second-line, third-line, and later therapy are unchanged from the 2017 update, the panel reports in the Journal of Clinical Oncology, and a further update is now planned for the care of stage IV NSCLC in patients with driver alterations.

medwireNews is an independent medical news service provided by Springer Healthcare. © 2020 Springer Healthcare part of the Springer Nature group

J Clin Oncol 2020; doi:10.1200/JCO.19.03022

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