Singh Navneet, Temin Sarah, Baker Sherman, Blanchard Elizabeth, Brahmer Julie R, Celano Paul, Duma Narjust, Ellis Peter M, Elkins Ivy B, Haddad Rami Y, Hesketh Paul J, Jain Dharamvir, Johnson David H, Leighl Natasha B, Mamdani Hirva, Masters Gregory, Moffitt Pamela R, Phillips Tanyanika, Riely Gregory J, Robinson Andrew G, Rosell Rafael, Schiller Joan H, Schneider Bryan J, Spigel David R, Jaiyesimi Ishmael A
Postgraduate Institute of Medical Education and Research, Chandigarh, India.
American Society of Clinical Oncology, Alexandria, VA.
J Clin Oncol. 2022 Oct 1;40(28):3323-3343. doi: 10.1200/JCO.22.00825. Epub 2022 Jul 11.
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.
ASCO updated recommendations on the basis of an ongoing systematic review of randomized clinical trials from 2018 to 2021.
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.
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.
提供基于证据的建议，更新2020年美国临床肿瘤学会（ASCO）和安大略省卫生厅（安大略癌症护理机构）关于无驱动基因突变的IV期非小细胞肺癌患者全身治疗的指南。
ASCO在对2018年至2021年随机临床试验进行持续系统评价的基础上更新了建议。
本指南更新反映了自上次更新以来证据的变化。五项随机临床试验提供了证据基础。关注的结果包括疗效和安全性。
除了2020年针对程序性死亡配体-1（PD-L1）高表达（肿瘤比例评分 [TPS]≥50%）、非鳞状细胞癌（非SCC）且体能状态（PS）为0-1的患者的治疗方案外，临床医生可提供阿替利珠单抗单药治疗。对于PD-L1高表达（TPS≥50%）、非SCC且PS为0-1的患者，临床医生可单独提供纳武利尤单抗和伊匹木单抗，或纳武利尤单抗和伊匹木单抗联合化疗。对于PD-L1表达阴性（0%）和低阳性（TPS 1%-49%）、非SCC且PS为0-1的患者，临床医生可单独提供纳武利尤单抗和伊匹木单抗，或纳武利尤单抗和伊匹木单抗联合化疗。对于PD-L1高表达、鳞状细胞癌（SCC）且PS为0-1的患者，临床医生可提供阿替利珠单抗单药治疗。对于PD-L1高表达、SCC且PS为0-1的患者，临床医生可单独提供纳武利尤单抗和伊匹木单抗，或与两个周期的铂类化疗联合使用。对于PD-L1表达阴性和低阳性、SCC且PS为0- l的患者，临床医生可单独提供纳武利尤单抗和伊匹木单抗，或与两个周期的铂类化疗联合使用。对于接受免疫检查点抑制剂和化疗作为一线治疗的非SCC患者，临床医生可提供二线紫杉醇加贝伐单抗治疗。对于接受化疗（含或不含贝伐单抗）和免疫检查点抑制剂治疗的非SCC患者，临床医生应提供三线单药培美曲塞、多西他赛或紫杉醇加贝伐单抗的治疗选择。更多信息可在www.asco.org/thoracic-cancer-guidelines获取。
