ASCO生存指南：无驱动基因改变的IV期非小细胞肺癌治疗

SCI

26 July 2022

Therapy for Stage IV Non–Small-Cell Lung Cancer Without Driver Alterations: ASCO Living Guideline

(Journal of Clinical Oncology, IF: 50.717)

• Navneet Singh, Sarah Temin, Sherman Baker Jr, Elizabeth Blanchard, Julie R. Brahmer, Paul Celano, Narjust Duma, Peter M. Ellis, Ivy B. Elkins, Rami Y. Haddad, Paul J. Hesketh, Dharamvir Jain, David H. Johnson, Natasha B. Leighl, Hirva Mamdani, Gregory Masters, Pamela R. Moffitt, Tanyanika Phillips, Gregory J. Riely, Andrew G. Robinson, Rafael Rosell, Joan H. Schiller, Bryan J. Schneider, David R. Spigel, and Ishmael A. Jaiyesimi

• CORRESPONDENCE TO: guidelines@asco.org

PURPOSE 目的

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.

提供基于证据的建议，更新2020年ASCO和安大略省健康（安大略省癌症护理）指南，对无驱动基因改变的IV期非小细胞肺癌患者进行系统治疗。

METHODS 方法

ASCO updated recommendations on the basis of an ongoing systematic review of randomized clinical trials from 2018 to 2021.

ASCO根据2018至2021正在进行的随机临床试验系统审查更新了建议。

RESULTS 结果

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.

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。相关结果包括疗效和安全性。

RECOMMENDATIONS 建议

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. 

除2020年高表达程序性死亡配体-1（PD-L1）患者的选择外（肿瘤比例评分[TPS]≥50%），非鳞状细胞癌（non-SCC），并且功能状态评分（PS）为0-1，临床医生可以提供单药阿替唑珠单抗。PD-L1高表达（TPS≥50%），非鳞状细胞癌，PS 0-1，临床医生可以单独使用阿替利珠单抗和伊匹木单抗，或阿替利珠单抗和伊匹木单抗加化疗。PD-L1表达阴性（0%）和低阳性（TPS 1%-49%）、非鳞状细胞癌和PS 0-1，临床医生可以单独使用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加化疗。由于PD-L1高表达、鳞状细胞癌和PS 0-1，临床医生可以提供单药阿替利珠单抗。由于PD-L1高表达、鳞状细胞癌（SCC）和PS 0-1，临床医生可以单独使用纳武利尤单抗和伊匹木单抗，或合并两个周期的基于铂的化疗联合使用。对于PD-L1表达阴性和低阳性、鳞状细胞癌和PS 0-1，临床医生可以单独使用纳武利尤单抗和伊匹木单抗或与两个基于铂的化疗周期联合使用。对于接受免疫检查点抑制剂和化疗作为一线治疗的非鳞状细胞癌患者，临床医生可能会提供二线紫杉醇加贝伐珠单抗。对于非鳞状细胞癌患者，无论是否接受化疗联合或部联合贝伐珠单抗和免疫检查点抑制剂治疗，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珠单抗的选择。

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