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
...atment
...ary of All Recommendati...
...or recommendations with multiple treatme...
...tion 1: What are the most effective f...
...growth factor receptor (EGFR...
...tion, Exon 21 L858R substitution...
...inicians should offer osimertinib. (,...
...offer osimertinib with chemotherapy...
...thers...
....For other activating EGFR alterations,...
...imertinib. (, , L , W )Qualifying S...
...d treatment following the non-drive...
....For any activating EGFR alteration,...
...xon 20 inserti...
...icians may offer chemotherapy and amivantamab....
...amab is not available, clinicians...
...lymphoma kinase (ALK)
...6.Clinicians should offer alectinib...
...7.If alectinib, brigatinib, or lorlatinib are no...
ROS...
...nicians may offer repotrectinib, entrectinib,...
...izotinib, entrectinib, or repotrectinib...
BRAFV60...
....Clinicians may offer dabrafenib and...
...abrafenib and trametinib, or encorafenib and b...
...n 14 skipping mutation...
.... Clinicians may offer capmatinib or te...
....13.If capmatinib or tepotinib is n...
RET rearrangem...
...linicians should offer selpercatinib. (, , H ,...
...f selpercatinib is not available, clinicians may o...
...tinib or pralsetinib are not avail...
Neurotrophic tyrosine receptor kinase (NTRK)...
...cians may offer entrectinib or larotrectinib. (, ,...
...ntrectinib or larotrectinib are not availa...
...patients with a poor performance status (PS)...
....20. Comprehensive genomic biomarker tes...
1.21. Patients with advanced lung c...
...uestion 2: What are the most effective second-li...
...Due to development of potentia...
EGFR
...ion, Exon 21 L858R substitution...
... For patients that develop EGFR T790M resistance...
...patients who have progressed on osimertinib or ot...
....2.1For patients who progressed on osimertinib...
Other...
...with an exon 20 insertion alteration who...
...LK
...or patients who have previously rece...
....5. For patients who have previously recei...
...OS1...
...patients who have previously receiv...
...s who have received multiple ROS-1 inhi...
BRAFV60...
...For patients who have not received BRAF therap...
...ents who have previously received BRAF or...
....10. For BRAF alterations other than...
...exon 14 skipping mutatio...
...atients who have not received MET-target...
...patients previously treated with MET-targeted t...
...rearrangemen...
...13. For patients who have not received a RET i...
.... If selpercatinib or pralsetinib is...
...RK rearrangement...
...atients who have not received an NTR...
...trectinib or larotrectinib is not available, cl...
...al receptor factor 2 (HER2)...
.... Clinicians may offer treatment with trast...
...RAS G12...
...inicians may offer treatment with sotoras...
...ns may offer treatment with adagrasib. (,...
...-Line and Subsequent Treatment Opt...
...igure 2. Treatment Options for Patients With Sta...
...st and Second Line Treatment Options for Pati...
...First and Second Line Treatment Options...