Navneet Singh1, Sarah Temin2, Sherman Baker3, Elizabeth Blanchard4, Julie R Brahmer5, Paul Celano6, Narjust Duma7, Peter M Ellis8, Ivy B Elkins9, Rami Y Haddad10, Paul J Hesketh11, Dharamvir Jain12, David H Johnson13, Natasha B Leighl14, Hirva Mamdani15, Gregory Masters16, Pamela R Moffitt17, Tanyanika Phillips18, Gregory J Riely19, Andrew G Robinson20, Rafael Rosell21, Joan H Schiller22, Bryan J Schneider23, David R Spigel24, Ishmael A Jaiyesimi25. 1. Postgraduate Institute of Medical Education and Research, Chandigarh, India. 2. American Society of Clinical Oncology, Alexandria, VA. 3. Virginia Commonwealth University, Richmond, VA. 4. Southcoast Centers for Cancer Care, New Bedford, MA. 5. Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD. 6. The Cancer Center at GBMC, Townson, MD. 7. Dana-Farber Cancer Institute, Boston, MA. 8. Juravinski Cancer Centre, Hamilton, Ontario, Canada. 9. EGFR Resisters, Buffalo Grove, IL. 10. Affiliated Oncologists, LLC, Chicago Ridge, IL. 11. Lahey Hospital and Medical Center, Burlington, MA. 12. Houston Methodist Cancer Center, Houston, TX. 13. University of Texas Southwestern Medical Center, Dallas, TX. 14. Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada. 15. Karmanos Cancer Institute/Wayne State University, Detroit, MI. 16. Helen F. Graham Cancer Center and Research Institute, Newark, DE. 17. Patient Advocate, Galva, IA. 18. City of Hope, Duarte, CA. 19. Memorial Sloan Kettering Cancer Center, New York, NY. 20. Kingston General Hospital, Queen's University, Ontario, Canada. 21. Catalan Institute of Oncology, Barcelona, Catalonia, Spain. 22. Inova Schar Cancer Institute, Falls Church, VA. 23. University of Michigan Health System, Ann Arbor, MI. 24. Sarah Cannon Research Institute, Nashville, TN. 25. Beaumont Health Royal Oak and Oakland University William Beaumont School of Medicine, Royal Oak, MI.
Abstract
PURPOSE: To provide evidence-based recommendations updating the 2020 ASCO and Ontario Health (Cancer Care Ontario) guideline on systemic therapy for patients with stage IV non-small-cell lung cancer without driver alterations. METHODS: ASCO updated recommendations on the basis of an ongoing systematic review of randomized clinical trials from 2018 to 2021. RESULTS: This guideline update reflects changes in evidence since the previous update. Five randomized clinical trials provide the evidence base. Outcomes of interest include efficacy and safety. RECOMMENDATIONS: In addition to 2020 options for patients with high programmed death ligand-1 (PD-L1) expression (tumor proportion score [TPS] ≥ 50%), nonsquamous cell carcinoma (non-SCC), and performance status (PS) 0-1, clinicians may offer single-agent atezolizumab. With high PD-L1 expression (TPS ≥ 50%), non-SCC, and PS 0-1, clinicians may offer nivolumab and ipilumumab alone or nivolumab and ipilimumab plus chemotherapy. With negative (0%) and low positive PD-L1 expression (TPS 1%-49%), non-SCC, and PS 0-1, clinicians may offer nivolumab and ipilimumab alone or nivolumab and ipilimumab plus chemotherapy. With high PD-L1 expression, SCC, and PS 0-1, clinicians may offer single-agent atezolizumab. With high PD-L1 expression, squamous cell carcinoma (SCC), and PS 0-1, clinicians may offer nivolumab and ipilimumab alone or in combination with two cycles of platinum-based chemotherapy. With negative and low positive PD-L1 expression, SCC, and PS 0-1, clinicians may offer nivolumab and ipilimumab alone or in combination with two cycles of platinum-based chemotherapy. With non-SCC who received an immune checkpoint inhibitor and chemotherapy as first-line therapy, clinicians may offer second-line paclitaxel plus bevacizumab. With non-SCC, who received chemotherapy with or without bevacizumab and immune checkpoint inhibitor therapy, clinicians should offer the options of third-line single-agent pemetrexed, docetaxel, or paclitaxel plus bevacizumab.Additional information is available at www.asco.org/thoracic-cancer-guidelines.
PURPOSE: To provide evidence-based recommendations updating the 2020 ASCO and Ontario Health (Cancer Care Ontario) guideline on systemic therapy for patients with stage IV non-small-cell lung cancer without driver alterations. METHODS: ASCO updated recommendations on the basis of an ongoing systematic review of randomized clinical trials from 2018 to 2021. RESULTS: This guideline update reflects changes in evidence since the previous update. Five randomized clinical trials provide the evidence base. Outcomes of interest include efficacy and safety. RECOMMENDATIONS: In addition to 2020 options for patients with high programmed death ligand-1 (PD-L1) expression (tumor proportion score [TPS] ≥ 50%), nonsquamous cell carcinoma (non-SCC), and performance status (PS) 0-1, clinicians may offer single-agent atezolizumab. With high PD-L1 expression (TPS ≥ 50%), non-SCC, and PS 0-1, clinicians may offer nivolumab and ipilumumab alone or nivolumab and ipilimumab plus chemotherapy. With negative (0%) and low positive PD-L1 expression (TPS 1%-49%), non-SCC, and PS 0-1, clinicians may offer nivolumab and ipilimumab alone or nivolumab and ipilimumab plus chemotherapy. With high PD-L1 expression, SCC, and PS 0-1, clinicians may offer single-agent atezolizumab. With high PD-L1 expression, squamous cell carcinoma (SCC), and PS 0-1, clinicians may offer nivolumab and ipilimumab alone or in combination with two cycles of platinum-based chemotherapy. With negative and low positive PD-L1 expression, SCC, and PS 0-1, clinicians may offer nivolumab and ipilimumab alone or in combination with two cycles of platinum-based chemotherapy. With non-SCC who received an immune checkpoint inhibitor and chemotherapy as first-line therapy, clinicians may offer second-line paclitaxel plus bevacizumab. With non-SCC, who received chemotherapy with or without bevacizumab and immune checkpoint inhibitor therapy, clinicians should offer the options of third-line single-agent pemetrexed, docetaxel, or paclitaxel plus bevacizumab.Additional information is available at www.asco.org/thoracic-cancer-guidelines.