Updated guidelines for treating stage IV non-small-cell lung cancer

The authors reviewed data from recent clinical trials to update guidelines on treating stage IV non-small-cell lung cancer (NSCLC). This article provided a summarized account of the updates included in the American Society of Clinical Oncology guidelines for treating NSCLC.

The American Society of Clinical Oncology (ASCO) provides guidelines for the most effective ways to treat stage IV NSCLC (cancer that has spread beyond the lung). As treatments advance and evolve, the guidelines must also be updated. New therapies include targeted therapies, that act on a specific pathway that allows the cancer cells to grow. These therapies can also target certain genetic mutations involved in cancer growth (such as EGFR, ALK, or ROS1). Immunotherapies stimulate the immune system to kill the cancer cells. The ASCO examined evidence from recent clinical trials to update the treatment guidelines.

This review discusses the updated 2017 guidelines for the treatment of stage IV NSCLC, particularly non-squamous and squamous cell carcinoma.

First line treatment

For patients without genetic mutations who were in good health and had high levels of a protein called PD-L1, the immune therapy drug pembrolizumab (Keytruda) was recommended. For similar patients who had low levels of PD-L1 protein, a combination of chemotherapy agents was recommended.

In patients with the EGFR mutation, targeted therapies such afatinib (Gilotrif), erlotinib (Tarceva), or gefitinib (Iressa) are recommended. Crizotinib (Xalkori) is recommended for ALK or ROS1 mutations.

Second line treatment

For patients with high levels of PD-L1 and without mutations who progressed after first line chemotherapy, the immunotherapies nivolumab (Opdivo), pembrolizumab or atezolizumab (Tecentriq) were recommended. For patients who progressed after first-line immunotherapies, chemotherapy was recommended.

Docetaxel (Taxotere) was recommended in patients who are not able to receive immune therapy after chemotherapy. Pemetrexed (Alimta) was recommended for patients with non-squamous NSCLC.

Osimertinib (Tagrisso) was recommended for patients with the T790M EGFR mutation who have progressed after targeted EGFR-TKI therapy. In similar patients without the T790M mutation, chemotherapy was recommended.

Crizotinib was recommended for patients with ROS1 mutations that have not been treated with crizotinib previously. Those who progressed past crizotinib treatment were recommended chemotherapy.

The authors provided updated guidelines on the most effective treatments for stage IV NSCLC based off recent clinical trials.