The American Society of Clinical Oncology (ASCO) recently updated its clinical guidelines for advanced non-small cell lung cancer (NSCLC) so that oncologists can select the most appropriate treatment for patients.
Treatments for the disease are evolving rapidly as scientific research advances. To update the 2015 guidelines, researchers reviewed 14 clinical trials published between February 2014 and December 2016, according to a news release. Those included nine Phase III randomized controlled trials (RCTs), four Phase II RCTs, one Phase II/III RCT, and six non-randomized studies on systemic therapy.
The updated guidelines recommend medication for patients who have not been treated previously for NSCLC (first-line treatment) and for patients who have been treated with a therapy that did not work or has stopped working (second-line treatment). Third-line treatment is a third attempt to treat a disease.
The update covers immune checkpoint inhibitors, which are biological agents that remove immune system cell blockage by tumors so that the body’s own defenses are freed up to kill tumor cells.
The guidelines recommend using the checkpoint inhibitor Keytruda (pembrolizumab) as a first-line treatment only in patients who have high levels of a protein called PD-L1, or programmed cell death ligand 1, found on a type of white blood cell called a T-cell. This is for patients without EGFR mutations or ALK or ROS1 gene rearrangements when no targeted therapies exist.
The same goes for second-line treatment where immune checkpoint inhibitors have not previously been tried. In this case, patients can receive either Keytruda, Tecentriq (atezolizumab), or Opdivo (nivolumab) as a stand-alone therapy.
Immune checkpoint inhibitors are also recommended for second-line treatment of patients with BRAF mutations in their tumors, causing a protein called B-raf to be altered. Tecentriq, Opdivo, or Keytruda are recommended for those patients who have high levels of PD-L1.
For fourth-line treatment, ASCO advises patients and clinicians to consider and discuss experimental treatment, clinical trials, and continued best supportive (palliative) care.
“For all recommendations, benefits outweigh harms,” the ASCO expert panel notes.
The panel also states that all patients must have received molecular testing, particularly for EGFR/ALK/ROS1 mutations and PD-L1 levels, before applying the new version of the guidelines.