Nasser H Hanna1, Bryan J Schneider2, Sarah Temin3, Sherman Baker4, Julie Brahmer5, Peter M Ellis6, Laurie E Gaspar7,8, Rami Y Haddad9, Paul J Hesketh10, Dharamvir Jain11, Ishmael Jaiyesimi12, David H Johnson13, Natasha B Leighl14, Tanyanika Phillips15, Gregory J Riely16, Andrew G Robinson17, Rafael Rosell18, Joan H Schiller19, Navneet Singh20, David R Spigel21, Janis O Stabler22, Joan Tashbar23, Gregory Masters24. 1. Indiana University Simon Cancer Center, Indianapolis, IN. 2. University of Michigan Health System, Ann Arbor, MI. 3. American Society of Clinical Oncology, Alexandria, VA. 4. Virginia Commonwealth University, Richmond, VA. 5. Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, MD. 6. Juravinski Cancer Centre, Hamilton, Ontario, Canada. 7. University of Colorado School of Medicine, Denver, CO. 8. Banner MD Anderson Cancer Center, Greeley, CO. 9. Affiliated Oncologists, Chicago Ridge, IL. 10. Lahey Hospital and Medical Center, Burlington, MA. 11. Norton Cancer Institute, Louisville, KY. 12. William Beaumont Hospital, Royal Oak, MI. 13. University of Texas Southwestern Medical Center, Dallas, TX. 14. Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada. 15. City of Hope, City of Duarte, CA. 16. Memorial Sloan Kettering Cancer Center, New York, NY. 17. Kingston General Hospital, School of Medicine, Queen's University, Ontario, Canada. 18. Catalan Institute of Oncology, Barcelona, Spain. 19. Inova Schar Cancer Institute, Falls Church, VA. 20. Postgraduate Institute of Medical Education and Research, Chandigarh, India. 21. Sarah Cannon Research Institute, Nashville, TN. 22. Patient advocate. 23. Circle of Hope for Cancer Research, St Cloud, FL. 24. Helen F. Graham Cancer Center and Research Institute, Newark, DE.
Abstract
PURPOSE: The aim of this work is to provide evidence-based recommendations updating the 2017 ASCO guideline on systemic therapy for patients with stage IV non-small-cell lung cancer (NSCLC) without driver alterations. A guideline update for patients with stage IV NSCLC with driver alterations will be published separately. METHODS: The American Society of Clinical Oncology and Ontario Health (Cancer Care Ontario) NSCLC Expert Panel made updated recommendations based on a systematic review of randomized controlled trials from December 2015 to 2019. RESULTS: This guideline update reflects changes in evidence since the previous guideline update. Five randomized controlled trials provide the evidence base. Additional literature suggested by the Expert Panel is discussed. RECOMMENDATIONS: Recommendations apply to patients without driver alterations in epidermal growth factor receptor or ALK. For patients with high programmed death ligand 1 (PD-L1) expression (tumor proportion score [TPS] ≥ 50%) and non-squamous cell carcinoma (non-SCC), the Expert Panel recommends single-agent pembrolizumab. Additional treatment options include pembrolizumab/carboplatin/pemetrexed, atezolizumab/carboplatin/paclitaxel/bevacizumab, or atezolizumab/carboplatin/nab-paclitaxel. For most patients with non-SCC and either negative (0%) or low positive (1% to 49%) PD-L1, the Expert Panel recommends pembrolizumab/carboplatin/pemetrexed. Additional options are atezolizumab/carboplatin/nab-paclitaxel, atezolizumab/carboplatin/paclitaxel/bevacizumab, platinum-based two-drug combination chemotherapy, or non-platinum-based two-drug therapy. Single-agent pembrolizumab is an option for low positive PD-L1. For patients with high PD-L1 expression (TPS ≥ 50%) and SCC, the Expert Panel recommends single-agent pembrolizumab. An additional treatment option is pembrolizumab/carboplatin/(paclitaxel or nab-paclitaxel). For most patients with SCC and either negative (0%) or low positive PD-L1 (TPS 1% to 49%), the Expert Panel recommends pembrolizumab/carboplatin/(paclitaxel or nab-paclitaxel) or chemotherapy. Single-agent pembrolizumab is an option in select cases of low positive PD-L1. Recommendations are conditional on the basis of histology, PD-L1 status, and/or the presence or absence of contraindications. Additional information is available at www.asco.org/lung-cancer-guidelines.
PURPOSE: The aim of this work is to provide evidence-based recommendations updating the 2017 ASCO guideline on systemic therapy for patients with stage IV non-small-cell lung cancer (NSCLC) without driver alterations. A guideline update for patients with stage IV NSCLC with driver alterations will be published separately. METHODS: The American Society of Clinical Oncology and Ontario Health (Cancer Care Ontario) NSCLC Expert Panel made updated recommendations based on a systematic review of randomized controlled trials from December 2015 to 2019. RESULTS: This guideline update reflects changes in evidence since the previous guideline update. Five randomized controlled trials provide the evidence base. Additional literature suggested by the Expert Panel is discussed. RECOMMENDATIONS: Recommendations apply to patients without driver alterations in epidermal growth factor receptor or ALK. For patients with high programmed death ligand 1 (PD-L1) expression (tumor proportion score [TPS] ≥ 50%) and non-squamous cell carcinoma (non-SCC), the Expert Panel recommends single-agent pembrolizumab. Additional treatment options include pembrolizumab/carboplatin/pemetrexed, atezolizumab/carboplatin/paclitaxel/bevacizumab, or atezolizumab/carboplatin/nab-paclitaxel. For most patients with non-SCC and either negative (0%) or low positive (1% to 49%) PD-L1, the Expert Panel recommends pembrolizumab/carboplatin/pemetrexed. Additional options are atezolizumab/carboplatin/nab-paclitaxel, atezolizumab/carboplatin/paclitaxel/bevacizumab, platinum-based two-drug combination chemotherapy, or non-platinum-based two-drug therapy. Single-agent pembrolizumab is an option for low positive PD-L1. For patients with high PD-L1 expression (TPS ≥ 50%) and SCC, the Expert Panel recommends single-agent pembrolizumab. An additional treatment option is pembrolizumab/carboplatin/(paclitaxel or nab-paclitaxel). For most patients with SCC and either negative (0%) or low positive PD-L1 (TPS 1% to 49%), the Expert Panel recommends pembrolizumab/carboplatin/(paclitaxel or nab-paclitaxel) or chemotherapy. Single-agent pembrolizumab is an option in select cases of low positive PD-L1. Recommendations are conditional on the basis of histology, PD-L1 status, and/or the presence or absence of contraindications. Additional information is available at www.asco.org/lung-cancer-guidelines.
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