Therapy for Stage IV Non-Small-Cell Lung Cancer With Driver Alterations
Key Points
Key Points
- The treatment of advanced stage IV non-small-cell lung cancer (NSCLC) has evolved dramatically in the past decade.
- The identification of actionable oncogenic driver alterations has allowed for the emergence of new, effective targeted treatments, that have resulted in significant survival gains.
Treatment
...reatme...
...of All Recommendations...
...recommendations with multiple tre...
...ion 1: What are the most effective first-line trea...
...rowth factor receptor (EGFR...
...letion, Exon 21 L858R substitution...
....Clinicians should offer osimertinib. (...
...1.or may offer osimertinib with chemotherapy. (,...
Othe...
...ther activating EGFR alterations, (G719X, L8...
...simertinib. (, , L , W )Qualifying...
...rd treatment following the non-driver...
...tivating EGFR alteration, regardless of...
...xon 20 insertions...
...may offer chemotherapy and amivantamab. (,...
...mivantamab is not available, clinic...
...lymphoma kinase (ALK)...
...ans should offer alectinib or brigatinib or l...
....7.If alectinib, brigatinib, or lorlati...
ROS1
...8Clinicians may offer repotrectini...
1.9If crizotinib, entrectinib, or repotrectinib...
...AFV600E...
...Clinicians may offer dabrafenib and trametinib, or...
...abrafenib and trametinib, or encorafenib an...
...n 14 skipping mutation...
... Clinicians may offer capmatinib or tepotini...
...capmatinib or tepotinib is not available, cli...
...earrangement...
...linicians should offer selpercatinib. (...
....If selpercatinib is not available, clinicians ma...
...selpercatinib or pralsetinib are not av...
...tyrosine receptor kinase (NTRK) rearrangement...
...7. Clinicians may offer entrectinib or larotrect...
... If entrectinib or larotrectinib are...
...nts with a poor performance status (PS), tyros...
...rehensive genomic biomarker test resul...
...Patients with advanced lung cancer should be ref...
Clinical Question 2: What are the most effec...
...Due to development of potentially targetable re...
EGFR
...deletion, Exon 21 L858R substitution
...For patients that develop EGFR T790M resistan...
...atients who have progressed on osimerti...
....2.1For patients who progressed on osi...
Others
...patients with an exon 20 insertion al...
AL...
...ients who have previously received cri...
...ents who have previously received other...
ROS...
...or patients who have previously rece...
...ents who have received multiple ROS-1...
...RAFV600...
...ts who have not received BRAF therapy, clinicians...
...or patients who have previously received...
...r BRAF alterations other than BRAFV600E...
...exon 14 skipping mutation
...For patients who have not received...
...For patients previously treated with MET-target...
...rearrangement...
... For patients who have not received a RET in...
...selpercatinib or pralsetinib is no...
...rearrangement...
...nts who have not received an NTRK inhibitor, cl...
...f entrectinib or larotrectinib is not avail...
...pidermal receptor factor 2 (HER2)...
....17. Clinicians may offer treatment with...
...RAS G12...
...Clinicians may offer treatment with...
...s may offer treatment with adagrasib. (, , L...
...ure 1. Second-Line and Subsequent Treatm...
...ment Options for Patients With Stage IV NSC...
...irst and Second Line Treatment Opti...
.... First and Second Line Treatment Opt...