The European Society for Medical Oncology (ESMO) has issued updated clinical practice guidelines for the diagnosis, treatment, and follow-up of metastatic non-small cell lung cancer (NSCLC).
The guidelines focus on treatment recommendations for the management of advanced/metastatic NSCLC, with an update on the role of immunotherapy and the use of targeted therapies for patients with tumours with specific gene mutations. Also included are personalised medicine recommendations and new treatment algorithms.
Updated recommendations compared to the 2018 version include:
- Combination of atezolizumab and carboplatin/nab-P followed by maintenance atezolizumab represents a new standard first-line treatment opportunity for non-squamous cell carcinoma (NSCC) [I, A; MCBS v1.1 score: 3]
- Dacomitinib has been added to the list of EGFR TKIs (erlotinib, gefitinib, or afatinib) recommended as first-line treatment for patients with a tumour with a sensitising EGFR mutation [I, A]. None of the four EGFR TKIs are consensually considered as a preferred option [IV, C].
- Early results from a phase 3 trial suggest ramucirumab (a human IgG1 VEGFR2 antagonist) in combination with erlotinib (versus erlotinib in combination with placebo) led to superior PFS (19.4 versus 12.4 months; HR 0.59, 95% CI 0.46-0.76; P
- Lorlatinib and brigatinib show efficacy among patients with ALK mutations at crizotinib resistance [III, A; MCBS score v1.1 score: 3].
- In patients ALK-rearranged NSCLC who progress after a second-generation ALK TKI, the next-generation ALK inhibitor lorlatinib is an option if available [III, A; MCBS score v1.1 score: 3].
- Patients with ROS1-rearranged NSCLC who have received crizotinib in the ﬁrst-line setting may be offered platinum-based (chemotherapy) ChT therapy in the second-line setting [IV, A], or preferably inclusion in clinical trials using new generation inhibitors.
The full guidelines and treatment algorithms can be found here.