Indiana University Simon Cancer Center, Indianapolis, IN.
University of Michigan Health System, Ann Arbor, MI.
J Clin Oncol. 2020 May 10;38(14):1608-1632. doi: 10.1200/JCO.19.03022. Epub 2020 Jan 28.
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.
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.
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 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.
本研究旨在为无驱动基因改变的 IV 期非小细胞肺癌（NSCLC）患者提供基于循证的 ASCO 2017 年系统治疗指南更新建议。将另外发表一篇针对存在驱动基因改变的 IV 期 NSCLC 患者的指南更新建议。
美国临床肿瘤学会和安大略省卫生厅（安大略省癌症护理）NSCLC 专家小组基于 2015 年 12 月至 2019 年的随机对照试验系统综述，制定了更新的推荐意见。
本指南更新反映了自上次指南更新以来证据的变化。五项随机对照试验提供了证据基础。专家组还讨论了额外的文献建议。
这些建议适用于无表皮生长因子受体或 ALK 驱动基因改变的患者。对于高程序性死亡配体 1（PD-L1）表达（肿瘤比例评分 [TPS]≥50%）且非鳞状细胞癌（非 SCC）患者，专家组建议使用单药 pembrolizumab。其他治疗选择包括 pembrolizumab/卡铂/培美曲塞、atezolizumab/卡铂/紫杉醇/贝伐珠单抗或 atezolizumab/卡铂/nab-紫杉醇。对于大多数非 SCC 且 PD-L1 阴性（0%）或低阳性（1%至 49%）的患者，专家组建议使用 pembrolizumab/卡铂/培美曲塞。其他选择包括 atezolizumab/卡铂/nab-紫杉醇、atezolizumab/卡铂/紫杉醇/贝伐珠单抗、铂类双药联合化疗或非铂类双药治疗。低阳性 PD-L1 患者可选择单药 pembrolizumab。对于高 PD-L1 表达（TPS≥50%）且 SCC 患者，专家组建议使用单药 pembrolizumab。另一种治疗选择是 pembrolizumab/卡铂/（紫杉醇或 nab-紫杉醇）。对于大多数 SCC 且 PD-L1 阴性（0%）或低阳性（TPS 1%至 49%）的患者，专家组建议使用 pembrolizumab/卡铂/（紫杉醇或 nab-紫杉醇）或化疗。低阳性 PD-L1 患者可选择单药 pembrolizumab。这些建议基于组织学、PD-L1 状态和/或有无禁忌证。更多信息可在 www.asco.org/lung-cancer-guidelines 上获取。
