Therapy for Stage IV Non-Small-Cell Lung Cancer With Driver Alterations

Publication Date: February 28, 2024

Key Points

Key Points

  • The treatment of advanced stage IV non-small-cell lung cancer (NSCLC) has evolved dramatically in the past decade.
  • The identification of actionable oncogenic driver alterations has allowed for the emergence of new, effective targeted treatments, that have resulted in significant survival gains.

Treatment

...reatment...

...tion 1: What are the most effective first-...

...ecommendations with multiple treatme...

...ermal growth factor receptor (EGFR)...

...on 19 deletion, Exon 21 L858R substi...

...icians should offer osimertinib. ( EB , , H ,...

Others

....2. For other activating EGFR alte...

...mertinib. ( IC , , L , W )618...

...dard treatment following the non-driver alterat...

...ualifying Statement: Recommendation 1.2, 1.2.1,...

...or any activating EGFR alteration, regardl...

...on 20 inserti...

...Clinicians may offer chemotherapy...

.... If amivantamab is not available, cl...

...stic lymphoma kinase (ALK)...

...linicians should offer alectinib or...

...If alectinib, brigatinib, or lorlatinib...

...OS1

...may offer crizotinib or entrectinib. ( EB , , M,...

...zotinib or entrectinib are not available...

...FV600E...

...0. Clinicians may offer dabrafenib an...

...dabrafenib and trametinib, or encorafenib and...

...on 14 skipping mutati...

...ians may offer capmatinib or tepotinib. ( EB ,...

...atinib or tepotinib is not available, clinician...

...ET rearrangeme...

...s should offer selpercatinib. ( EB , , H ,...

...If selpercatinib is not available, clinici...

...selpercatinib or pralsetinib are not...

...otrophic tyrosine receptor kinase (N...

.... Clinicians may offer entrectinib or laro...

.... If entrectinib or larotrectinib are not ava...

...patients with a poor performance status (P...

...Comprehensive genomic biomarker test...

Qualifying Statement: PDL-1 IHC alone should not...

.... Patients with advanced lung canc...


...uestion 2: What are the most effective second...

...Due to development of potentially targetable r...

EGF...

...tion, Exon 21 L858R substitution...

...For patients that develop EGFR T790M resistance...

...or patients who have progressed on osimer...

...ing Statement: Anti-PD-(L)1 agents with plati...

Other...

...For patients with an exon 20 insertion...

...LK

...ents who have previously received crizotin...

...For patients who have previously received ot...

ROS...

....6. For patients who have previousl...

...inicians should offer platinum-based ch...

BRAFV60...

....8. For patients who have not received...

...9. For patients who have previously received BRAF...

2.10. For BRAF alterations other than BRAFV600E a...

...ET exon 14 skipping...

...patients who have not received MET-targete...

...ients previously treated with MET-ta...

...earrangement...

....13. For patients who have not rece...

...rcatinib or pralsetinib is not avail...

...TRK rearrangeme...

...patients who have not received an NTRK inhi...

2.16. If entrectinib or larotrectin...

...n epidermal receptor factor 2 (HER2)...

...s may offer treatment with trastuzumab d...

...RAS G12C

...ians may offer treatment with sotorasi...

...cians may offer treatment with ada...

...Statement: Note that adagrasib and sotorasi...


...ond-Line and Subsequent Treatment Options for Pa...


...gure 2. Treatment Options for Patients With...


...3. First and Second Line Treatment Options for...


Figure 3. First and Second Line Treatme...