Adeno or Other in Stage IV NSCLC Treatment
| Genetics | % | Treatment |
|---|---|---|
| EGFR | ~15 | 1st line: osimertinib if L858R, ex19del (NEJM 2018;378:113) |
| EGFR ex20 insertion | 2–3 | Subsequent Rx w/ amivantamab (JCO 2021;39:3391) or mobocertinib (JAMA Onc 2021;7:e214761) after platinum chemo |
| ALK | ~4 | 1st line: alectinib pref. b/c CNS activity (NEJM 2017;377:829) |
| ROS1 | 2 | Crizotinib pref. (JCO 2017;35:2613); entrectinib (Lancet Onc 2020;21:261) |
| MET ex14 skip or amplif. | 3 | Capmatinib (NEJM 2020;383:944) or tepotinib (NEJM 2020;383:931) |
| RET | 1 | Selpercatinib (NEJM 2020;383:813) or pralsetinib (Lancet Onc 2021;22: 959-969) |
| BRAF V600E | 1–3 | Dabrafenib + trametinib (Lancet Onc 2016;17:984) |
| NTRK fusions | <1 | Larotrectinib (NEJM 2018;378:731) |
| KRAS G12C | ~13 | Subsequent Rx w/ sotorasib (NEJM 2021;384:2371) |
| PD-L1≥50% | 30 | Pembrolizumab or chemo + pembro (NEJM 2018;378:2078) |
No targets & PD-L1 <50% :
-
Chemo (carbo/pemetrexed) + pembro (NEJM 2018;378:2078) Pembrolizumab plus Chemotherapy in Metastatic Non–Small-Cell Lung Cancer
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carbo/paclitaxel + anti-VEGF Ab (bevacizumab) + atezo (NEJM 2018;378:2288)