Lung cancer

ASCO Releases Updated NSCLC Guidelines

The American Society of Clinical Oncology (ASCO) has updated its 2015 guidelines on systemic therapy for stage IV non-small-cell lung cancer (NSCLC).

In order to update their 2015 guidelines, the ASCO NSCLC Expert Panel conducted a systematic review of randomized controlled trials from February 2014 to December 2016, as well as the Cancer Care Ontario Program in Evidence-Based Care’s update of a previous ASCO evidence search. Fourteen trials provided the evidence base and earlier phase trials informed the recommendation’s development.
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Among the new or revised recommendations:

  • For first line therapy in patients with non-squamous cell carcinoma or squamous cell carcinoma (without positive markers), if the patient has high PD-L1 expression, pembrolizumab should be used alone, and if the patient has low PD-L1 expression, clinicians should offer standard chemotherapy.
  • For second line therapy in patients who received first-line chemotherapy, without prior immune checkpoint therapy, if NSCLC tumor is positive for PD-L1 expression, clinicians should use singleagent nivolumab, pembrolizumab, or atezolizumab; if tumor has negative or unknown PD-L1 expression, clinicians should use nivolumab or atezolizumab.
  • For patients who cannot receive immune checkpoint inhibitor after chemotherapy, docetaxel is recommended, and in patients with nonsquamous NSCLC, pemetrexed is recommended.

“The Panel encourages investigators to conduct studies in those listed areas for which evidence is currently lacking and/or insufficient. The Panel leadership will evaluate new evidence as part of the standard guideline update process.”

—Michael Potts

Hanna N, Johnson D, Temin S, et al. Systemic therapy for stage IV non–small-cell lung cancer: American Society of Clinical Oncology clinical practice guideline update [published online August 14, 2017]. JCO. DOI: 10.1200/JCO.2017.74.6065.