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Systemic Treatment for Patients with Advanced Non-Small Cell Lung Cancer

Version: 3 ID: 7-10 Nov 2016
Type of Content: Guidelines & Advice, Clinical
Document Status: In-Review
Authors:
P.M. Ellis, E.T. Vella, Y.C. Ung, The Lung Cancer Disease Site Group

Guideline Objective

The guideline objective is to determine the most effective systemic treatment options in terms of overall survival, quality of life, and response in the management of advanced non-small cell lung cancer (NSCLC).

Patient Population

This guideline targets adult and elderly patients with advanced NSCLC who are candidates for systemic therapy. Advanced disease is defined as stage IV and stage IIIB not amenable to curative treatment approaches.

Intended Guideline Users

The intended users of this guideline are oncologists involved in the systemic treatment of patients with NSCLC.

Research Question(s)

  • Which patients with stage IIIB/IV NSCLC should be treated with chemotherapy?
  • What is the most effective first-line therapy for patients with stage IIIB/IV NSCLC with NSCC, negative or unknown EGFR-sensitizing mutation and ALK gene rearrangement status, and PS 0 to 1 or possibly PS 2?
  • What is the most effective first-line therapy for patients with stage IIIB/IV NSCLC with negative or unknown EGFR/ALK status, NSCC, and no contraindications to bevacizumab?
  • What is the most effective first-line therapy for patients with stage IIIB/IV NSCLC with PS 2, NSCC, and negative or unknown EGFR-sensitizing mutation and ALK gene rearrangement status?
  • What is the most effective first-line therapy for patients with stage IIIB/IV NSCLC with SCC, negative or unknown EGFR-sensitizing mutation and ALK gene rearrangement status, and PS 0 to 1 or possibly PS 2?
  • What is the most effective first-line therapy for patients with stage IIIB/IV NSCLC with negative or unknown EGFR/ALK status, SCC, and PS 2?
  • What is the most effective first-line therapy for patients with stage IIIB/IV NSCLC with an EGFR-sensitizing mutation and PS 0 to 1 or possibly PS 2?
  • What is the most effective first-line therapy for patients with stage IIIB/IV NSCLC with ALK gene rearrangement and PS 0 to 1 or possibly PS 2?
  • What is the most effective first-line therapy for patients with stage IIIB/IV NSCLC with ROS1 rearrangement, no ALK gene rearrangement, negative or unknown EGFR-sensitizing mutation status, and PS 0 to 1 or possibly PS 2?
  • What is the most effective first-line therapy for patients with stage IIIB/IV NSCLC with negative or unknown EGFR/ALK status and large-cell neuroendocrine carcinoma?
  • What is the most effective second-line therapy for patients with stage IIIB/IV NSCLC with a sensitizing EGFR mutation who received a first-line EGFR TKI and experienced disease progression?
  • What is the most effective second-line therapy for patients with stage IIIB/IV NSCLC with a sensitizing EGFR mutation who received a first-line EGFR TKI and experienced disease progression after an initial response?
  • What is the most effective second-line therapy for patients with stage IIIB/IV NSCLC with ALK rearrangement with progression after first-line crizotinib?
  • What is the optimal second-line treatment for elderly patients with stage IIIB/IV NSCLC?
  • Is there a role for third-line therapy or beyond in the treatment of stage IIIB/IV NSCLC?
  • What is the best chemotherapy for treatment of elderly patients with stage IIIB/IV NSCLC?
  • What is the optimal treatment for patients with stable disease or response after four cycles of cytotoxic chemotherapy?
  • What is the most effective second-line therapy for patients with stage IIIB/IV NSCLC with negative or unknown EGFR/ALK status and NSCC?
  • What is the most effective second-line therapy for patients with stage IIIB/IV NSCLC with negative or unknown EGFR/ALK status and SCC?
  • Do immune checkpoint inhibitors improve patient outcomes compared with chemotherapy in patients with advanced NSCLC?
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