Stage IV Non-Small Cell Lung Cancer without Driver Alterations

Publication Date: July 11, 2023

Key Points

Key Points

  • In 2022, ASCO launched living clinical practice guidelines for systemic therapy for patients with stage IV non–small-cell lung cancer (NSCLC) with1 and without driver alterations.2 Based on new evidence from routine literature searches, this version of the stage IV non–small-cell lung cancer without driver alterations living guideline reviews evidence and provides updated recommendations on new therapeutics.
1. Singh N, Temin S, Baker S, Jr., et al: Therapy for Stage IV Non-Small-Cell Lung Cancer With Driver Alterations: ASCO Living Guideline. J Clin Oncol:JCO2200824, 2022
2. Singh N, Temin S, Baker S, Jr., et al: Therapy for Stage IV Non-Small-Cell Lung Cancer Without Driver Alterations: ASCO Living Guideline. J Clin Oncol:JCO2200825, 2022

  • This update (Recommendation 7.2) recommends not adding bevaizumab to permetrexed plus carboplatin.

Diagnosis

...Diagnosis...

...ions of PD-L1 Tumor Proportion Score (T...


Treatment

...Treatment...

...A1. Chemo...

...tients with performance status (PS)...

...here is no cure for patients with stage...


...A2. Firs...

...tients with high PD-L1/PD1 expression (TPS...

...or patients with high PD-L1/PD1 expre...

...ts with high PD-L1/PD1 expression (...

...patients with high PD-L1/PD1 expressio...

...patients with high PD-L1/PD1 expression (TPS ...

...ition to 2020 options, for patients with high PD-L...

....6. In addition to 2020 options, for pa...

...n addition to 2020 options, for pa...

...patients with high PD-L1/PD1 expression (TPS...

...No Contraindications to Be...

...or patients receiving carboplatin plus pa...

...izumab should not be added to pemetrexed plus ca...

...patients with negativ...

2.1. For patients with negat...

...For patients with negative...

....3. For patients with negat...

...For patients with negative (...

...patients with negative (...

...ts with low positive PD-L1 expression (TP...

...tion to 2020 options, for patients with nega...

...r patients with non-SCC, PD-L1 TPS 0–49% and...

...patients with non-SCC, PD-L1 TPS 0–49% and...

...PS 2...

...( EB , B , I , W )618...

...care ( EB , B , I , S )618


A3....

...r patients with high PD-L1 expression (TPS ...

3.1. For patients with high PD-L1 expression (TPS...

...tients with high PD-L1 expression (...

...n to 2020 options, for patients with high P...

...to 2020 options, for patients with high...

...addition to 2020 options, for patients...

...Negative or Unknown...

...ts with negative (TPS 0%,...

...ents with negative (TPS 0%,...

...r patients with negative (TPS 0%,...

...3. For patients with negative (TPS...

...For patients with low positive PD-L1 (TPS 1%–49...

4.5. In addition to 2020 recommendatio...

4.6. For patients with SCC, PD-L1 TPS 0–49% and...

...patients with SCC, PD-L1 TPS 0–49% and PS 0 t...

...PS 2

Chemotherapy ( EB , B , I ,...

...iative care ( EB , B , I , S )618...


...B1...

...Squamous an...

...patients who received first-line chemotherapy and...

...ith negative or unknown tumor PDL-1 e...

...re are insufficient data to recommend...

...ians should offer standard platinum-based c...

...based two-drug therapy if platinum is co...

...ith contraindications to immune checkpoint inh...

...Non-squamous Onl...

...on-SCC who have not previously received pemetr...

...ddition to previously recommended regimens, for...


...t-Line Treatment Options for Patients...


...Second-Line Treatment Options for Pat...


...-Line Treatment Options for Patients With Stage...


...B2....

...ence does not support the selection of a specific...


....1. For the majority of patients with non-SCC, who...


...D1. For Cytot...

...not sufficient to make a recommendation for...


...believes that cancer clinical trials are vital to...