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Therapy for Stage IV Non-Small-Cell Lung Cancer Without Driver Alterations: ASCO Living Guideline
Navneet Singh1, Sarah Temin2, Sherman Baker3
1Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Summary
Updated guidelines recommend new systemic therapies for stage IV non-small-cell lung cancer without driver alterations. These evidence-based recommendations include options for various programmed death ligand-1 (PD-L1) expression levels and cancer subtypes.
Area of Science:
- Medical Oncology
- Clinical Guidelines
- Thoracic Cancers
Background:
- Stage IV non-small-cell lung cancer (NSCLC) without driver alterations presents complex treatment challenges.
- Previous guidelines from ASCO and Ontario Health (Cancer Care Ontario) established initial treatment paradigms.
Purpose of the Study:
- To update evidence-based recommendations for systemic therapy in stage IV NSCLC without driver alterations.
- To incorporate recent clinical trial data into treatment guidelines.
Main Methods:
- An ongoing systematic review of randomized clinical trials (2018-2021) was conducted.
- Efficacy and safety outcomes were primary considerations for evidence evaluation.
Main Results:
- New recommendations cover single-agent atezolizumab, and combinations of nivolumab and ipilimumab (with or without chemotherapy) for various PD-L1 expression levels and NSCLC subtypes (squamous and non-squamous).
- Second- and third-line treatment options for non-squamous NSCLC include paclitaxel plus bevacizumab, pemetrexed, docetaxel, and nivolumab/ipilimumab combinations.
Conclusions:
- The updated guideline provides clinicians with expanded evidence-based options for systemic therapy in stage IV NSCLC.
- These recommendations aim to optimize treatment selection based on PD-L1 expression, histology, and performance status.
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