ASCO updates stage IV NSCLC guidelines

  • Hanna NH & al.
  • J Clin Oncol
  • 28 Jan 2020

  • Oncology guidelines update
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Takeaway

  • The American Society for Clinical Oncology (ASCO) has updated the section of the 2017 ASCO guideline on systemic treatment of patients with stage IV NSCLC that applies to patients without driver alterations.

Why this matters

  • This new update includes potentially practice-changing data from 5 phase 3 randomized clinical trials published since the 2017 guidelines.

Key points

  • First-line therapy recommendations:
    • Single-agent pembrolizumab for high programmed death ligand 1 (PD-L1) expression (tumor proportion score [TPS] ≥50%), nonsquamous cell carcinoma (non-SCC) and SCC, and performance status (PS) 0-1.
    • Pembrolizumab/carboplatin/pemetrexed for negative (0%) and low positive PD-L1 expression (TPS 1%-49%), non-SCC, and PS 0-1 in eligible patients.
    • Pembrolizumab/carboplatin/paclitaxel or nab-paclitaxel for negative and low positive PD-L1 expression, SCC, and PS 0-1.
    • Standard chemotherapy with platinum-based 2-drug combinations for negative and low positive PD-L1 expression, SCC, and PS 0-1 and contraindications to immunotherapy.
    • Standard chemotherapy with non-platinum-based 2-drug combinations for negative and low positive PD-L1 expression, SCC, and PS 0-1, and contraindications to immunotherapy and platinum-based therapy.
  • Recommendations for second- and third-line therapies are unchanged.
  • An update on recommendations for patients with stage IV NSCLC with driver alterations will be published separately.