Therapy for Stage IV Non-Small-Cell Lung Cancer With Driver Alterations

Publication Date: February 28, 2024

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

...on 1: What are the most effective first-l...

...For recommendations with multiple treat...

...wth factor receptor (EGFR)...

...9 deletion, Exon 21 L858R substitut...

...cians should offer osimertinib. ( EB , , H , S )...

...hers

...ther activating EGFR alterations, (G719X, L8...

....1. or osimertinib. ( IC , , L , W )6...

...2. or standard treatment following the...

...ement: Recommendation 1.2, 1.2.1, and 1...

1.3. For any activating EGFR alteration, rega...

Exon 20 inse...

.... Clinicians may offer chemotherapy and amivantam...

...ntamab is not available, clinicians s...

...aplastic lymphoma kinase...

...ns should offer alectinib or brigatinib or lorlati...

...nib, brigatinib, or lorlatinib are not availab...

ROS...

...icians may offer crizotinib or entr...

...If crizotinib or entrectinib are n...

BRAFV600E

...cians may offer dabrafenib and tram...

...nib and trametinib, or encorafenib...

...xon 14 skipping mutati...

...Clinicians may offer capmatinib o...

....13. If capmatinib or tepotinib is...

...rearrangeme...

...icians should offer selpercatinib. ( EB ,...

...f selpercatinib is not available, clinicians may...

.... If selpercatinib or pralsetinib...

...tyrosine receptor kinase (NTRK) rearrange...

...linicians may offer entrectinib or larot...

...trectinib or larotrectinib are not availabl...

.... For patients with a poor performance status (PS...

...rehensive genomic biomarker test r...

...ying Statement: PDL-1 IHC alone should not be u...

...ients with advanced lung cancer should be referred...


...ion 2: What are the most effective s...

...e to development of potentially targetab...

EGF...

...letion, Exon 21 L858R substitu...

...s that develop EGFR T790M resistance alt...

...atients who have progressed on osimertinib or...

Qualifying Statement: Anti-PD-(L)1 agents with pla...

...ther...

...For patients with an exon 20 insertion alterati...

...LK...

...tients who have previously received...

...patients who have previously received o...

ROS1

...or patients who have previously received criz...

....7. Clinicians should offer platinum-based...

...FV600E...

2.8. For patients who have not received BRAF the...

...tients who have previously received BRAF or MEK...

...10. For BRAF alterations other than...

...ET exon 14 skipping m...

...tients who have not received MET-targete...

...ients previously treated with MET-targete...

...T rearrangement...

...nts who have not received a RET inhibi...

...rcatinib or pralsetinib is not ava...

...rearrangement

...15. For patients who have not recei...

2.16. If entrectinib or larotrectinib is not...

...epidermal receptor factor 2...

...may offer treatment with trastuzum...

...AS G12C...

...Clinicians may offer treatment with sotorasib....

...Clinicians may offer treatment with adagrasib. (...

Qualifying Statement: Note that ad...


...igure 1. Second-Line and Subsequent...


...igure 2. Treatment Options for Patients Wi...


...and Second Line Treatment Options for Patients...


...and Second Line Treatment Options for Patients Wit...