Non-Small Cell Lung Cancer Treatment Regimens
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Non-Small Cell Lung Cancer Treatment Regimens |
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Clinical Trials: The NCCN recommends cancer patient participation in clinical trials as the gold standard for treatment. |
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Cancer therapy selection, dosing, administration, and the management of related adverse events can be a complex process that should be handled by an experienced healthcare team. Clinicians must choose and verify treatment options based on the individual patient; drug dose modifications and supportive care interventions should be administered accordingly. The cancer treatment regimens below may include both U.S. Food and Drug Administration-approved and unapproved indications/regimens. These regimens are only provided to supplement the latest treatment strategies. These Guidelines are a work in progress that may be refined as often as new significant data becomes available. The National Comprehensive Cancer Network Guidelines® are a consensus statement of its authors regarding their views of currently accepted approaches to treatment. Any clinician seeking to apply or consult any NCCN Guidelines® is expected to use independent medical judgment in the context of individual clinical circumstances to determine any patient’s care or treatment. The NCCN makes no warranties of any kind whatsoever regarding their content, use, or application and disclaims any responsibility for their application or use in any way. |
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Note: All recommendations are category 2A unless otherwise indicated. |
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▶Systemic Therapy for Advanced or Metastatic Cancer1 |
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REGIMEN |
DOSING |
Sensitizing EGFR Mutation Positive: First-Line |
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Preferred |
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Osimertinib (Category 1)2-5,a-c |
Osimertinib 80mg orally once daily. |
Other Recommended Regimens |
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Afatinib (Category 1)6-8,a-c |
Afatinib 40mg orally once daily. |
Dacomitinib (Category 1)9,10,a-c |
Dacomitinib 45mg orally once daily. |
Erlotinib (Category 1)11-16,a-c |
Erlotinb 150mg orally once daily. |
Erlotinib + Ramucirumab11,17,18,a-c |
Days 1-28: Erlotinib 150mg orally once daily Repeat cycle every 4 weeks, with: Day 1: Ramucirumab 10mg/kg IV over 60 minutes. Repeat cycle every 2 weeks. |
Gefitinib (Category 1)19-22,a-c |
Gefitinib 250mg orally once daily. |
Useful in Certain Circumstances |
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Erlotinib + Bevacizumab (Category 2B)11,23,24,d |
Days 1-28: Erlotinib 150mg orally once daily Repeat cycle every 4 weeks, with: Day 1: Bevacizumab 15mg/kg IV. Repeat cycle every 3 weeks. |
Sensitizing EGFR Mutation Positive: Subsequent Therapy |
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Afatinib (Category 1)6-8,a-c |
Afatinib 40mg orally once daily. |
Afatinib + Cetuximab6,25,26,a-c |
Days 1-14: Afatinib 40mg orally once daily Day 1: Cetuximab 500mg/m2 IV. Repeat cycle every 2 weeks. |
Dacomitinib (Category 1)9,10,a-c |
Dacomitinib 45mg orally once daily. |
Erlotinib + Bevacizumab (Category 2B)11,23,24,d |
Days 1-28: Erlotinib 150mg orally once daily Repeat cycle every 4 weeks, with: Day 1: Bevacizumab 15mg/kg IV. Repeat cycle every 3 weeks. |
Erlotinib + Ramucirumab11,17,18 |
Days 1-28: Erlotinib 150mg orally once daily Repeat cycle every 4 weeks, with: Day 1: Ramucirumab 10mg/kg IV over 60 minutes. Repeat cycle every 2 weeks. |
Gefitinib (Category 1)19-22,a-c |
Gefitinib 250mg orally once daily. |
Osimertinib2-5,a-c |
Osimertinib 80mg orally once daily. |
ALK Rearrangement-Positive: First-Line Therapy |
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Preferred |
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Alectinib (Category 1)27-30,a,e |
Alectinib 600mg orally twice daily. |
Other Recommended Regimens |
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Brigantinb (Category 1)31-33,a,e |
Days 1-7: Brigatinib 90mg once daily, followed by: Days 8-28: Brigatinib 180mg orally once daily Administer for one 28-day cycle, followed by: Days 1-28: Brigatinib 180mg orally once daily. Repeat cycle every 4 weeks. |
Ceritinib (Category 1)34-38,a,e |
Ceritinib 450mg orally once daily. |
Useful in Certain Circumstances |
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Crizotinib (Category 1)30,39-42,a,e |
Crizotinib 250mg orally twice daily. |
ALK Rearrangement-Positive: Subsequent Therapy |
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Alectinib27-30,a |
Alectinib 600mg orally twice daily. |
Brigatinib31-33,a |
Days 1-7: Brigatinib 90mg once daily, followed by: Days 8-28: Brigatinib 180mg orally once daily Administer for one 28-day cycle, followed by: Days 1-28: Brigatinib 180mg orally once daily. Repeat cycle every 4 weeks. |
Ceritinib34-38,a |
Ceritinib 450mg orally once daily. |
Crizotinib30,39-42,a |
Crizotinib 250mg orally twice daily. |
Lorlatinib43-45,a |
Lorlatinib 100mg orally once daily. |
ROS1 Rearrangement-Positive: First-Line Therapy |
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Preferred |
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Crizotinib30.39-42,a,f |
Crizotinib 250mg orally twice daily. |
Entrectinib46-47,a,f |
Entrectinib 600mg orally once daily. |
Other Recommended Regimens |
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Ceritinib34-38,a,f |
Ceritinib 450mg orally once daily. |
BRAF V600E Mutation Positive: First-Line Therapy |
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Preferred |
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Dabrafenib + Trametinib48-51,g,h |
Dabrafenib 150mg orally twice daily Trametinib 2mg orally once daily. |
Other Recommended Regimens |
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Dabrafenib46,52,53,g,h |
Dabrafenib 150mg orally twice daily. |
Vemurafenib54-56,g,h |
Vemurafenib 960mg orally twice daily. |
Useful in Certain Circumstances |
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See Initial systemic therapy options for Adenocarcinoma or Squamous Cell Carcinoma1 |
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NTRK Gene Fusion-Positive: First-Line |
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Preferred |
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Entrectinib46-47,i |
Entrectinib 600mg orally once daily. |
Larotrectinib57-59,i |
Larotrectinib 100mg orally twice daily. |
Useful in Certain Circumstances |
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See Initial systemic therapy options for Adenocarcinoma or Squamous Cell Carcinoma1 |
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MET Exon 14 Skipping Mutation: First-Line |
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Preferred |
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Capmatinib60-61,j |
Capmatinib 400mg orally twice daily. |
Useful in Certain Circumstances |
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Crizotinib30,39-42,j |
Crizotinib 250mg orally twice daily. |
See Initial systemic therapy options for Adenocarcinoma or Squamous Cell Carcinoma1 |
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RET Rearrangement-Positive: First-Line |
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Preferred |
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Pralsetinib62,63,k |
Pralsetinib 400mg orally once daily. |
Selpercatinib64,65,k |
Selpercatinib (less than 50 kg): 120 mg orally twice daily. Selpercatinib (50 kg or greater): 160 mg orally twice daily. |
Useful in Certain Circumstances |
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Cabozantinib66,67,k |
Cabozantinib 60mg orally once daily. |
Vandetanib (Category 2B)68,69,k |
Vandetanib 300mg orally once daily (starting dose). |
Other Recommended Regimens |
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See Initial systemic therapy options for Adenocarcinoma or Squamous Cell Carcinoma1 |
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PD-L1 Expression-Positive (≥50%) and EGFR, ALK, ROS1, BRAF, MET Exon 14 Skipping Mutation, and RET Negative, and No Contraindications to PD-1 or PD-L1 Inhibitors (PS 0-2): First-Line Therapy |
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Adenocarcinoma, Large Cell, NSCLC NOSl |
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Preferred |
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Atezolizumab70,72,l |
Day 1: Atezolizumab 1,200mg IV. Repeat cycle every 3 weeks. OR Day 1: Atezolizumab 840mg IV Repeat cycle every 2 weeks. OR Day 1: Atezolizumab 1,680mg IV Repeat cycle every 4 weeks. |
Carboplatin + Pemetrexed + Pembrolizumab (Category 1)73-75,l |
Day 1: Pembrolizumab 200mg IV over 30 minutes, followed by: Day 1: Pemetrexed 500mg/m2 IV over 10 minutes Day 1: Carboplatin AUC 5 IV over 30 minutes. Repeat every 3 weeks for 4-6 cycles.e |
Cisplatin + Pemetrexed + Pembrolizumab (Category 1)73,75,76,l |
Day 1: Pembrolizumab 200mg IV over 30 minutes, followed by: Day 1: Pemetrexed 500mg/m2 IV over 10 minutes Day 1: Cisplatin 75mg/m2 IV over 60 minutes. Repeat cycle every 3 weeks for 4-6 cycles.e |
Pembrolizumab75-79,l |
Day 1: Pembrolizumab 200mg IV over 30 minutes. Repeat cycle every 3 weeks for up to 2 years of therapy. OR Day 1: Pembrolizumab 400mg IV over 30 minutes. Repeat cycle every 42 days for up to 2 years of therapy. |
Other Recommended Regimens |
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Carboplatin + Albumin-Bound Paclitaxel + Atezolizumab70,80,l |
Day 1: Atezolizumab 1,200mg IV, followed by: Days 1,8,15: Albumin-Bound Paclitaxel 100mg/m2 IV over 30 minutes Day 1: Carboplatin AUC 6 IV over 30 minutes. Repeat cycle every 3 weeks for 4-6 cycles. |
Carboplatin + Paclitaxel + Bevacizumab + Atezolizumab (Category 1)23,70,71,d,l |
Day 1: Atezolizumab 1,200mg IV Day 1: Bevacizumab 15mg/kg IV Day 1: Paclitaxel 200mg/m2 IV over 3 hours Day 1: Carboplatin AUC 6 IV over 30 minutes. Repeat cycle every 3 weeks for 4-6 cycles.d OR Day 1: Atezolizumab 1,200mg IV, followed by: Day 1: Bevacizumab 15mg/kg IV Day 1: Paclitaxel 175mg/m2 (for Asian patients) over 3 hours Day 1: Carboplatin AUC 6 IV over 30 minutes. Repeat cycle every 3 weeks for 4-6 cycles. |
Nivolumab + Ipilimumab + Pemetrexed + Carboplatin81-83 |
Days 1,22: Nivolumab 360mg IV over 30 minutes, followed by: Day 1: Ipilimumab 1mg/kg IV over 30 minutes, followed by: Days 1,22: Pemetrexed 500mg/m2 IV over 10 minutes Days 1,22: Carboplatin AUC 6 IV over 30 minutes. Administer for one 42-day cycle, followed by: Days 1,22: Nivolumab 360mg IV over 30 minutes, followed by: Day 1: Ipilimumab 1mg/kg IV over 30 minutes. Repeat cycle every 42 days for a maximum of 2 years. |
Nivolumab + Ipilimumab + Pemetrexed + Cisplatin81-83 |
Days 1,22: Nivolumab 360mg IV over 30 minutes, followed by: Day 1: Ipilimumab 1mg/kg IV over 30 minutes, followed by: Days 1,22: Pemetrexed 500mg/m2 IV over 10 minutes Days 1,22: Cisplatin 75mg/m2 IV over 2 hours. Administer for one 42-day cycle, followed by: Days 1,22: Nivolumab 360mg IV over 30 minutes, followed by: Day 1: Ipilimumab 1mg/kg IV over 30 minutes. Repeat cycle every 42 days for a maximum of 2 years. |
Useful in Certain Circumstances |
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Nivolumab + Ipilimumab81,82,84 |
Days 1, 15, and 29: Nivolumab 3mg/kg over 30 minutes, followed by: Day 1: Ipilimumab 1mg/kg IV over 30 minutes. Repeat cycle every 42 days for a maximum of 2 years. |
Squamous Cell Carcinomam |
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Preferred |
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Atezolizumab70-72,m |
Day 1: Atezolizumab 1,200mg IV. Repeat cycle every 3 weeks. OR Day 1: Atezolizumab 840mg IV. Repeat cycle every 2 weeks. OR Day 1: Atezolizumab 1,680mg IV. Repeat cycle every 4 weeks. |
Carboplatin + Albumin-Bound Paclitaxel + Pembrolizumab (Category 1)75,76,85,m |
Day 1: Pembrolizumab 200mg IV over 30 minutes, followed by: Days 1,8,15: Albumin-bound Paclitaxel 100mg/m2 over 30 minutes Day 1: Carboplatin AUC 6 IV over 30 minutes. Repeat every 3 weeks for 4 cycles. |
Carboplatin + Paclitaxel + Pembrolizumab (Category 1)75,76,85,m |
Day 1: Pembrolizumab 200mg IV over 30 minutes, followed by: Day 1: Paclitaxel 200mg/m2 IV over 3 hours Day 1: Carboplatin AUC 6 IV over 30 minutes. Repeat every 3 weeks for 4 cycles.g |
Pembrolizumab (Category 1)75-79,m |
Day 1: Pembrolizumab 200mg IV over 30 minutes. Repeat cycle every 3 weeks for up to 2 years of therapy. OR Day 1: Pembrolizumab 400mg IV over 30 minutes. Repeat cycle every 42 days for up to 2 years of therapy. |
Other Recommended Regimens |
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Nivolumab + Ipilimumab + Paclitaxel + Carboplatin81-83 |
Days 1,22: Nivolumab 360mg IV over 30 minutes, followed by: Day 1: Ipilimumab 1mg/kg IV over 30 minutes, followed by: Days 1,22: Paclitaxel 200mg/m2 IV over 3 hours, followed by: Days 1,22: Carboplatin AUC 6 IV over 30 minutes. Administer for one 42-day cycle, followed by: Days 1,22: Nivolumab 360mg IV, followed by: Day 1: Ipilimumab 1mg/kg IV over 30 minutes. Repeat cycle every 42 days for a maximum of 2 years. |
Useful in Certain Circumstances |
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Nivolumab + Ipilimumab81,82,84 |
Days 1, 15, and 29: Nivolumab 3mg/kg over 30 minutes, followed by: Day 1: Ipilimumab 1mg/kg IV over 30 minutes. Repeat cycle every 42 days for a maximum of 2 years. |
PD-L1 Expression-Positive (≥50%) and EGFR, ALK, ROS1, BRAF, MET Exon 14 Skipping Mutation and RET Negative, and No Contraindications to PD-1 or PD-L1 Inhibitors (PS 0-2): Continuation Maintenance Therapy |
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Adenocarcinoma, Large Cell, NSCLC NOS |
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Atezolizumab68-70 |
Day 1: Atezolizumab 1,200mg IV. Repeat cycle every 3 weeks. OR Day 1: Atezolizumab 840mg IV. Repeat cycle every 2 weeks. OR Day 1: Atezolizumab 1,680mg IV. Repeat cycle every 4 weeks. |
Atezolizumab + Bevacizumab (Category 1)23,70,71,d |
Day 1: Atezolizumab 1,200mg IV Day 1: Bevacizumab 15mg/kg IV. Repeat cycle every 3 weeks. |
Pembrolizumab (Category 1)75-79 |
Day 1: Pembrolizumab 200mg IV over 30 minutes. Repeat cycle every 3 weeks for up to 2 years of therapy. OR Day 1: Pembrolizumab 400mg IV over 30 minutes. Repeat cycle every 42 days for up to 2 years of therapy. |
Pembrolizumab + Pemetrexed (Category 1)73,74,76 |
Day 1: Pembrolizumab 200mg IV over 30 minutes, followed by: Day 1: Pemetrexed 500mg/m2 IV over 10 minutes Repeat cycle every 3 weeks for a maximum total of 35 cycles of Pembrolizumab, followed by: Day 1: Pemetrexed 500mg/m2 IV over 10 minutes. Repeat cycle every 3 weeks.l |
Squamous Cell Carcinoma |
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Atezolizumab70-72 |
Day 1: Atezolizumab 1,200mg IV. Repeat cycle every 3 weeks. OR Day 1: Atezolizumab 840mg IV. Repeat cycle every 2 weeks. OR Day 1: Atezolizumab 1,680mg IV. Repeat cycle every 4 weeks. |
Pembrolizumab (Category 1)75-79 |
Day 1: Pembrolizumab 200mg IV over 30 minutes. Repeat cycle every 3 weeks for up to 2 years of therapy. OR Day 1: Pembrolizumab 400mg IV over 30 minutes. Repeat cycle every 42 days for up to 2 years of therapy. |
PD-L1 Expression-Positive (1-49%) and EGFR, ALK, ROS1, BRAF, MET Exon 14 Skipping Mutation, and RET Negative, and No Contraindications to PD-1 or PD-L1 Inhibitors (PS 0-2): First-Line Therapy |
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Adenocarcinoma, Large Cell, NSCLC NOS |
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Preferred |
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Carboplatin + Pemetrexed + Pembrolizumab (Category 1)73-77,n |
Day 1: Pembrolizumab 200mg IV over 30 minutes, followed by: Day 1: Pemetrexed 500mg/m2 IV over 10 minutes Day 1: Carboplatin AUC 5 IV over 30 minutes. Repeat every 3 weeks for 4-6 cycles.e |
Cisplatin + Pemetrexed + Pembrolizumab (Category 1)73,75,76,n |
Day 1: Pembrolizumab 200mg IV over 30 minutes, followed by: Day 1: Pemetrexed 500mg/m2 IV over 10 minutes Day 1: Cisplatin 75mg/m2 IV over 60 minutes. Repeat cycle every 3 weeks for 4-6 cycles.e |
Other Recommended Regimens |
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Carboplatin + Albumin-Bound Paclitaxel + Atezolizumab (Category 1)70.80,n |
Day 1: Atezolizumab 1,200mg IV, followed by: Days 1,8,15: Albumin-Bound Paclitaxel 100mg/m2 IV over 30 minutes Day 1: Carboplatin AUC 6 IV over 30 minutes. Repeat cycle every 3 weeks for 4-6 cycles. |
Carboplatin + Paclitaxel + Bevacizumab + Atezolizumab (Category 1)23,70,71,n |
Day 1: Atezolizumab 1,200mg IV Day 1: Bevacizumab 15mg/kg IV Day 1: Paclitaxel 200mg/m2 IV over 3 hours Day 1: Carboplatin AUC 6 IV over 30 minutes. Repeat cycle every 3 weeks for 4-6 cycles.d |
Nivolumab + Ipilimumab + Pemetrexed + Carboplatin81-83 |
Days 1,22: Nivolumab 360mg IV over 30 minutes, followed by: Day 1: Ipilimumab 1mg/kg IV over 30 minutes, followed by: Days 1,22: Pemetrexed 500mg/m2 IV over 10 minutes Days 1,22: Carboplatin AUC 6 IV over 30 minutes. Administer for one 42-day cycle, followed by: Days 1,22: Nivolumab 360mg IV over 30 minutes, followed by: Day 1: Ipilimumab 1mg/kg IV over 30 minutes. Repeat cycle every 42 days for a maximum of 2 years. |
Nivolumab + Ipilimumab + Pemetrexed + Cisplatin81-83 |
Days 1,22: Nivolumab 360mg IV over 30 minutes, followed by: Day 1: Ipilimumab 1mg/kg IV over 30 minutes, followed by: Days 1,22: Pemetrexed 500mg/m2 IV over 10 minutes Days 1,22: Cisplatin 75mg/m2 IV over 2 hours. Administer for one 42-day cycle, followed by: Days 1,22: Nivolumab 360mg IV over 30 minutes, followed by: Day 1: Ipilimumab 1mg/kg IV over 30 minutes. Repeat cycle every 42 days for a maximum of 2 years. |
Useful in Certain Circumstances |
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Nivolumab + Ipilimumab81,82,84 |
Days 1, 15, and 29: Nivolumab 3mg/kg over 30 minutes, followed by: Day 1: Ipilimumab 1mg/kg IV over 30 minutes. Repeat cycle every 42 days for a maximum of 2 years. |
Pembrolizumab (Category 2B)75-79,o |
Day 1: Pembrolizumab 200mg IV over 30 minutes. Repeat cycle every 3 weeks for up to 2 years of therapy. OR Day 1: Pembrolizumab 400mg IV over 30 minutes. Repeat cycle every 42 days for up to 2 years of therapy. |
Squamous Cell Carcinomao |
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Preferred |
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Carboplatin + Albumin-Bound Paclitaxel + Pembrolizumab (Category 1)75,76,85,o |
Day 1: Pembrolizumab 200mg IVk over 30 minutes, followed by: Days 1,8,15: Albumin-bound Paclitaxel 100mg/m2 over 30 minutes Day 1: Carboplatin AUC 6 IV over 30 minutes. Repeat every 3 weeks for 4 cycles. |
Carboplatin + Paclitaxel + Pembrolizumab (Category 1)75,76,85 |
Day 1: Pembrolizumab 200mg IV over 30 minutes, followed by: Day 1: Paclitaxel 200mg/m2 IV over 3 hours Day 1: Carboplatin AUC 6 IV over 30 minutes. Repeat every 3 weeks for 4 cycles.g |
Other Recommended Regimens |
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Nivolumab + Ipilimumab + Paclitaxel + Carboplatin81-83 |
Days 1,22: Nivolumab 360mg IV over 30 minutes, followed by: Day 1: Ipilimumab 1mg/kg IV over 30 minutes, followed by: Days 1,22: Paclitaxel 200mg/m2 IV over 3 hours, followed by: Days 1,22: Carboplatin AUC 6 IV over 30 minutes. Administer for one 42-day cycle, followed by: Days 1,22: Nivolumab 360mg IV, followed by: Day 1: Ipilimumab 1mg/kg IV over 30 minutes. Repeat cycle every 42 days for a maximum of 2 years. |
Useful in Certain Circumstances |
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Nivolumab + Ipilimumab81,82,84 |
Days 1, 15, and 29: Nivolumab 3mg/kg over 30 minutes, followed by: Day 1: Ipilimumab 1mg/kg IV over 30 minutes. Repeat cycle every 42 days for a maximum of 2 years. |
Pembrolizumab (Category 2B)75-79,o |
Day 1: Pembrolizumab 200mg IV over 30 minutes. Repeat cycle every 3 weeks for up to 2 years of therapy. OR Day 1: Pembrolizumab 400mg IV over 30 minutes. Repeat cycle every 42 days for up to 2 years of therapy. |
PD-L1 Expression-Positive (≥1-49%) and EGFR, ALK, ROS1, BRAF, MET Exon 14 Skipping Mutation and RET Negative, and No Contraindications to PD-1 or PD-L1 Inhibitors: Continuation Maintenance Therapy |
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Adenocarcinoma, Large Cell, NSCLC NOS |
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Atezolizumab70-72 |
Day 1: Atezolizumab 1,200mg IV. Repeat cycle every 3 weeks. OR Day 1: Atezolizumab 840mg IV. Repeat cycle every 2 weeks. OR Day 1: Atezolizumab 1,680mg IV. Repeat cycle every 4 weeks. |
Atezolizumab + Bevacizumab (Category 1)23,70,71,d |
Day 1: Atezolizumab 1,200mg IV Day 1: Bevacizumab 15mg/kg IV. Repeat cycle every 3 weeks. |
Pembrolizumab75-79 |
Day 1: Pembrolizumab 200mg IV over 30 minutes. Repeat cycle every 3 weeks for up to 2 years of therapy. OR Day 1: Pembrolizumab 400mg IV over 30 minutes. Repeat cycle every 42 days for up to 2 years of therapy. |
Pembrolizumab + Pemetrexed73,74,76 |
Day 1: Pembrolizumab 200mg IV over 30 minutes OR Day 1: Pembrolizumab 400mg IV over 30 minutes every other cycle, followed by: Day 1: Pemetrexed 500mg/m2 IV over 10 minutes. Repeat cycle every 3 weeks until 2 years of therapy has been completed, followed by: Day 1: Pemetrexed 500mg/m2 IV. Repeat cycle every 3 weeks. |
Squamous Cell Carcinoma |
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Pembrolizumab75-79 |
Day 1: Pembrolizumab 200mg IV over 30 minutes. Repeat cycle every 3 weeks for up to 2 years of therapy. OR Day 1: Pembrolizumab 400mg IV over 30 minutes. Repeat cycle every 42 days for up to 2 years of therapy. |
Adenocarcinoma, Large Cell, NSCLC NOS (PS 0-1): Initial Systemic Therapyp-s |
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No Contraindications to PD-1 or PD-L1 Inhibitors |
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Preferred |
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Pembrolizumab + Carboplatin + Pemetrexed (Category 1)73-76 |
Day 1: Pembrolizumab 200mg IV over 30 minutes, followed by: Day 1: Pemetrexed 500mg/m2 IV over 10 minutes Day 1: Carboplatin AUC 5 IV over 30 minutes. Repeat every 3 weeks for 4-6 cycles.e |
Pembrolizumab + Cisplatin + Pemetrexed (Category 1)73,75,76 |
Day 1: Pembrolizumab 200mg IV over 30 minutes, followed by: Day 1: Pemetrexed 500mg/m2 IV over 10 minutes Day 1: Cisplatin 75mg/m2 IV over 60 minutes. Repeat cycle every 3 weeks for 4-6 cycles. |
Other Recommended Regimens |
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Atezolizumab + Carboplatin + Paclitaxel + Bevacizumab (Category 1)23,70,71,d |
Day 1: Atezolizumab 1,200mg IV Day 1: Bevacizumab 15mg/kg IV Day 1: Paclitaxel 200mg/m2 IV over 3 hours Day 1: Carboplatin AUC 6 IV over 30 minutes. Repeat cycle every 3 weeks for 4-6 cycles. OR Day 1: Atezolizumab 1,200mg IV, followed by: Day 1: Bevacizumab 15mg/kg IV Day 1: Paclitaxel 175mg/m2 (for Asian patients) over 3 hours Day 1: Carboplatin AUC 6 IV over 30 minutes. Repeat cycle every 3 weeks for 4-6 cycles |
Atezolizumab + Carboplatin + Albumin-Bound Paclitaxel70,80 |
Day 1: Atezolizumab 1,200mg IV, followed by: Days 1,8,15: Albumin-Bound Paclitaxel 100mg/m2 IV over 30 minutes Day 1: Carboplatin AUC 6 IV over 30 minutes. Repeat cycle every 3 weeks for 4-6 cycles. |
Nivolumab + Ipilimumab81,82,84 |
Days 1, 15, and 29: Nivolumab 3mg/kg over 30 minutes, followed by: Day 1: Ipilimumab 1mg/kg IV over 30 minutes. Repeat cycle every 42 days for a maximum of 2 years. |
Nivolumab + Ipilimumab + Pemetrexed + Carboplatin79-81 |
Days 1,22: Nivolumab 360mg IV over 30 minutes, followed by: Day 1: Ipilimumab 1mg/kg IV over 30 minutes, followed by: Days 1,22: Pemetrexed 500mg/m2 IV over 10 minutes Days 1,22: Carboplatin AUC 6 IV over 30 minutes. Administer for one 42-day cycle, followed by: Days 1,22: Nivolumab 360mg IV over 30 minutes, followed by: Day 1: Ipilimumab 1mg/kg IV over 30 minutes. Repeat cycle every 42 days for a maximum of 2 years. |
Nivolumab + Ipilimumab + Pemetrexed + Cisplatin81-83 |
Days 1,22: Nivolumab 360mg IV over 30 minutes, followed by: Day 1: Ipilimumab 1mg/kg IV over 30 minutes, followed by: Days 1,22: Pemetrexed 500mg/m2 IV over 10 minutes Days 1,22: Cisplatin 75mg/m2 IV over 2 hours. Administer for one 42-day cycle, followed by: Days 1,22: Nivolumab 360mg IV over 30 minutes, followed by: Day 1: Ipilimumab 1mg/kg IV over 30 minutes. Repeat cycle every 42 days for a maximum of 2 years. |
Contraindications to PD-1 or PD-L1 Inhibitors |
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Useful in Certain Circumstances |
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Bevacizumab + Carboplatin + Paclitaxel (Category 1)23,86,d |
Day 1: Bevacizumab 15mg/kg IV Day 1: Paclitaxel 200mg/m2 IV over 3 hours, followed by: Day 1: Carboplatin AUC 6 IV over 30 minutes. Repeat cycle every 3 weeks for 6 cycles. |
Bevacizumab + Carboplatin + Pemetrexed23,87,d |
Day 1: Bevacizumab 15mg/kg IV Day 1: Pemetrexed 500mg/m2 IV over 10 minutes Day 1: Carboplatin AUC 6 IV over 30 minutes. Repeat cycle every 3 weeks for 4-6 cycles. |
Bevacizumab + Cisplatin + Pemetrexed23,88,d |
Day 1: Bevacizumab 7.5mg/kg IV Day 1: Pemetrexed 500mg/m2 IV over 10 minutes Day 1: Cisplatin 75mg/m2 IV over 60 minutes. Repeat cycle every 3 weeks for 4-6 cycles. |
Carboplatin + Albumin-Bound Paclitaxel89 (Category 1) |
Days 1,8,15: Albumin-bound Paclitaxel 100mg/m2 IV over 30 minutes Day 1: Carboplatin AUC 6 IV over 30 minutes. Repeat cycle every 3 weeks for 4-6 cycles. |
Carboplatin + Docetaxel (Category 1)90 |
Day 1: Docetaxel 75mg/m2 IV over 60 minutes, followed by: Day 1: Carboplatin AUC 6 IV over 30 minutes. Repeat cycle every 3 weeks for 4-6 cycles. |
Carboplatin + Etoposide (Category 1)91,92 |
Days 1-3: Etoposide 100mg/m2 IV over 30 minutes daily Day 1: Carboplatin AUC 5 IV over 30 minutes. Repeat cycle every 3 weeks for 4-6 cycles. |
Carboplatin + Gemcitabine (Category 1)91 |
Days 1,8,15: Gemcitabine 1,000mg/m2 IV over 30 minutes Day 1: Carboplatin AUC 5 IV over 30 minutes. Repeat cycle every 4 weeks for 4-6 cycles. |
Carboplatin + Paclitaxel (Category 1)94 |
Day 1: Paclitaxel 200mg/m2 IV over 3 hours, followed by: Day 1: Carboplatin AUC 6 IV over 30 minutes. Repeat cycle every 3 weeks for 4-6 cycles. |
Carboplatin + Pemetrexed (Category 1)93 |
Day 1: Pemetrexed 500mg/m2 IV over 10 minutes Day 1: Carboplatin AUC 6 IV over 30 minutes. Repeat cycle every 3 weeks for 4-6 cycles. |
Cisplatin + Docetaxel (Category 1)90 |
Day 1: Docetaxel 75mg/m2 IV over 60 minutes, followed by: Day 1: Cisplatin 75mg/m2 IV over 60 minutes. Repeat cycle every 3 weeks for 4-6 cycles. |
Cisplatin + Etoposide (Category 1)96 |
Day 1: Cisplatin 100mg/m2 IV over 60 minutes Days 1-3: Etoposide 100mg/m2 IV over 60 minutes daily. Repeat cycle every 3 weeks for 4-6 cycles. |
Cisplatin + Gemcitabine (Category 1)95,96 |
Days 1 and 8: Gemcitabine 1,000-1,250mg/m2 IV over 30 minutes, followed by: Day 1: Cisplatin 75-80mg/m2 IV over 60 minutes. Repeat cycle every 3 weeks for 4-6 cycles. |
Cisplatin + Paclitaxel (Category 1)99 |
Day 1: Paclitaxel 135mg/m2 IV over 3 hours, followed by: Day 1: Cisplatin 75mg/m2 IV over 60 minutes. Repeat cycle every 3 weeks for 4-6 cycles. |
Cisplatin + Pemetrexed (Category 1)100 |
Day 1: Pemetrexed 500mg/m2 IV over 10 minutes Day 1: Cisplatin 75mg/m2 IV over 60 minutes. Repeat cycle every 3 weeks for 4-6 cycles. |
Gemcitabine + Docetaxel (Category 1)101 |
Days 1 and 8: Gemcitabine 1,000-1,250mg/m2 IV over 30 minutes Day 8: Docetaxel 85mg/m2 IV over 60 minutes, followed by: Day 8: Gemcitabine 1000mg/m2 IV over 30 minutes. Repeat cycle every 3 weeks for 4-6 cycles. |
Gemcitabine + Vinorelbine (Category 1)102 |
Days 1 and 8: Vinorelbine 25mg/m2 IV over 5-10 minutes Days 1 and 8: Gemcitabine 1,000mg/m2 IV over 30 minutes. Repeat cycle every 3 weeks for 4-6 cycles. |
Adenocarcinoma, Large Cell, NSCLC NOS (PS 2): Initial Systemic Therapyp-s |
|
Preferred |
|
Carboplatin + Pemetrexed95 |
Day 1: Pemetrexed 500mg/m2 IV over 10 minutes Day 1: Carboplatin AUC 6 IV over 30 minutes. Repeat cycle every 3 weeks for 4-6 cycles. |
Other Recommended Regimens |
|
Carboplatin + Albumin-Bound Paclitaxel89 |
Days 1,8,15: Albumin-bound Paclitaxel 100mg/m2 IV over 30 minutes Day 1: Carboplatin AUC 6 IV over 30 minutes. Repeat cycle every 3 weeks for 4-6 cycles. |
Carboplatin + Docetaxel90 |
Day 1: Docetaxel 75mg/m2 IV over 60 minutes, followed by: Day 1: Carboplatin AUC 6 IV over 30 minutes. Repeat cycle every 3 weeks for 4-6 cycles. |
Carboplatin + Etoposide91,92 |
Days 1-3: Etoposide 100mg/m2 IV over 30 minutes daily Day 1: Carboplatin AUC 5 IV over 30 minutes. Repeat cycle every 3 weeks for 4-6 cycles. |
Carboplatin + Gemcitabine93 |
Days 1,8,15: Gemcitabine 1,000mg/m2 IV over 30 minutes Day 1: Carboplatin AUC 6 IV over 30 minutes. Repeat cycle every 4 weeks for 4-6 cycles. |
Carboplatin + Paclitaxel94 |
Day 1: Paclitaxel 200mg/m2 IV over 3 hours, followed by: Day 1: Carboplatin AUC 6 IV over 30 minutes. Repeat cycle every 3 weeks for 4-6 cycles. |
Useful in Certain Circumstances |
|
Albumin-Bound Paclitaxel103,104 |
Day 1: Albumin-bound Paclitaxel 260mg/m2 IV over 30 minutes. Repeat cycle every 3 weeks for 4-6 cycles. OR Days 1,8,15: Albumin-bound Paclitaxel 125mg/m2 IV over 30 minutes. Repeat cycle every 4 weeks for 4-6 cycles. |
Docetaxel105,106 |
Day 1: Docetaxel 75mg/mg IV over 60 minutes. Repeat cycle every 3 weeks for 4-6 cycles. |
Gemcitabine98,107,108 |
Days 1,8,15: Gemcitabine 1,000-1,250mg/m2 IV over 30 minutes. Repeat cycle every 4 weeks for 4-6 cycles. OR Days 1 and 8: Gemcitabine 1,250mg/m2 IV over 30 minutes. Repeat cycle every 3 weeks for 4-6 cycles. |
Gemcitabine + Docetaxel101 |
Day 1: Gemcitabine 1,000mg/m2 IV over 30 minutes Day 8: Docetaxel 85mg/m2 IV over 60 minutes, followed by: Day 8: Gemcitabine 1,000mg/m2 IV over 30 minutes. Repeat every 3 weeks for 4-6 weeks. |
Gemcitabine + Vinorelbine102 |
Days 1 and 8: Vinorelbine 25mg/m2 IV over 5-10 minutes Days 1 and 8: Gemcitabine 1,000mg/m2 IV over 30 minutes. Repeat cycle every 3 weeks for 4-6 cycles. |
Paclitaxel109-111 |
Day 1: Paclitaxel 200-225mg/m2 IV over 3 hours. Repeat cycle every 3 weeks for 4-6 cycles. OR Days 1,8,15: Paclitaxel 80mg/m2 IV over 60 minutes. Repeat cycle every 4 weeks for 4-6 cycles. |
Pemetrexed112-114 |
Day 1: Pemetrexed 500mg/m2 IV over 10 minutes. Repeat cycle every 3 weeks for 4-6 cycles. |
Adenocarcinoma, Large Cell, NSCLC NOS (PS 0-2): Continuation Maintenance |
|
Atezolizumab70-72 |
Day 1: Atezolizumab 1,200mg IV. Repeat cycle every 3 weeks. OR Day 1: Atezolizumab 840mg IV. Repeat cycle every 2 weeks. OR Day 1: Atezolizumab 1,680mg IV. Repeat cycle every 4 weeks. |
Atezolizumab + Bevacizumab (Category 1)23,70,71,d |
Day 1: Atezolizumab 1,200mg IV Day 1: Bevacizumab 15mg/kg IV. Repeat cycle every 3 weeks. |
Bevacizumab (Category 1)23,86,d |
Day 1: Bevacizumab 15mg/kg IV. Repeat cycle every 3 weeks. |
Bevacizumab + Pemetrexed (Category 1)23,87,88,d |
Day 1: Pemetrexed 500mg/m2 IV over 10 minutes Day 1: Bevacziumab 7.5-15mg/kg IV. Repeat cycle every 3 weeks. |
Gemcitabine (Category 2B)98,107,108 |
Days 1,8,15: Gemcitabine 1,000-1,250mg/m2 IV over 30 minutes. Repeat cycle every 4 weeks. OR Days 1 and 8: Gemcitabine 1,250mg/m2 IV over 30 minutes. Repeat cycle every 3 weeks. |
Pemetrexed (Category 1)112-114 |
Day 1: Pemetrexed 500mg/m2 IV over 10 minutes. Repeat every 3 weeks. |
Pembrolizumab + Pemetrexed (Category 1)71,72,74 |
Day 1: Pembrolizumab 200mg IV over 30 minutes, followed by: Day 1: Pembrolizumab 200mg over 30 minutes OR Day 1: Pembrolizumab 400mg IV over 30 minutes every other cycle, followed by: Day 1: Pemetrexed 500mg/m2 IV over 10 minutes. Repeat cycle every 3 weeks until 2 years of therapy has been completed, followed by: Day 1: Pemetrexed 500mg/m2 IV. Repeat cycle every 3 weeks. |
Adenocarcinoma, Large Cell, NSCLC NOS (PS 0-2): Switch Maintenance |
|
Pemetrexed112-114 |
Day 1: Pemetrexed 500mg/m2 IV over 10 minutes. Repeat every 3 weeks. |
Adenocarcinoma, Large Cell, NSCLC NOS (PS 0-2): Subsequent Therapy |
|
Preferred |
|
Atezolizumab (Category 1)70-72 |
Day 1: Atezoliziumab 1,200mg IV. Repeat cycle every 3 weeks. OR Day 1: Atezolizumab 840mg IV. Repeat cycle every 2 weeks. OR Day 1: Atezolizumab 1,680mg IV. Repeat cycle every 4 weeks. |
Nivolumab (Category 1)81,115-118 |
Day 1: Nivolumab 240mg IV over 30 minutes. Repeat cycle every 2 weeks. OR Day 1: Nivolumab 480mg IV over 30 minutes. Repeat cycle every 4 weeks. |
Pembrolizumab (Category 1)75-79 |
Day 1: Pembrolizumab 200mg IV over 30 minutes. Repeat cycle every 3 weeks for up to 2 years of therapy. OR Day 1: Pembrolizumab 400mg IV over 30 minutes. Repeat cycle every 42 days for up to 2 years of therapy. |
Other Recommended Therapy |
|
Docetaxel105,106 |
Day 1: Docetaxel 75mg/m2 IV over 60 minutes. Repeat every 3 weeks. |
Gemcitabine98,107,108 |
Days 1,8,15: Gemcitabine 1,000-1,250mg/m2 IV over 30 minutes. Repeat cycle every 4 weeks. OR Days 1 and 8: Gemcitabine 1,250mg/m2 IV over 30 minutes. Repeat cycle every 3 weeks. |
Pemetrexed112-114 |
Day 1: Pemetrexed 500mg/m2 IV over 10 minutes. Repeat cycle every 3 weeks. |
Ramucirumab + Docetaxel17,119 |
Day 1: Ramucirumab 10mg/kg IV over 60 minutes Day 1: Docetaxel 75mg/m2 IV over 60 minutes. Repeat cycle every 3 weeks. |
Squamous Cell Carcinoma (PS 0-1): Initial Systemic Therapyp-r,t |
|
No Contraindications to PD-1 or PD-L1 Inhibitors |
|
Preferred |
|
Pembrolizumab + Carboplatin + Albumin-Bound Paclitaxel (Category 1)75,76,85 |
Day 1: Pembrolizumab 200mg IV over 30 minutes, followed by: Days 1,8,15: Albumin-bound Paclitaxel 100mg/m2 IV over 30 minutes Day 1: Carboplatin AUC 6 IV over 30 minutes. Repeat cycle every 3 weeks for 4 cycles. |
Pembrolizumab + Carboplatin + Paclitaxel (Category 1)75,76,85 |
Day 1: Pembrolizumab 200mg IV over 30 minutes, followed by: Day 1: Paclitaxel 200mg/m2 IV over 3 hours Day 1: Carboplatin AUC 6 over 30 minutes. Repeat cycle every 3 weeks for 4 cycles. |
Other Recommended Regimens |
|
Nivolumab + Ipilimumab81,82,84 |
Days 1, 15, and 29: Nivolumab 3mg/kg over 30 minutes, followed by: Day 1: Ipilimumab 1mg/kg IV over 30 minutes. Repeat cycle every 42 days for a maximum of 2 years. |
Nivolumab + Ipilimumab + Paclitaxel + Carboplatin79-81 |
Days 1,22: Nivolumab 360mg IV over 30 minutes, followed by: Day 1: Ipilimumab 1mg/kg IV over 30 minutes, followed by: Days 1,22: Paclitaxel 200mg/m2 IV over 3 hours, followed by: Days 1,22: Carboplatin AUC 6 IV over 30 minutes. Administer for one 42-day cycle, followed by: Days 1,22: Nivolumab 360mg IV, followed by: Day 1: Ipilimumab 1mg/kg IV over 30 minutes. |
Contraindications to PD-1 or PD-L1 Inhibitors |
|
Useful in Certain Circumstances |
|
Carboplatin + Albumin-Bound Paclitaxel (Category 1)89 |
Days 1,8,15: Albumin-bound Paclitaxel 100mg/m2 IV over 30 minutes Day 1: Carboplatin AUC 6 IV over 30 minutes. Repeat cycle every 3 weeks for 4-6 cycles. |
Carboplatin + Docetaxel (Category 1)90 |
Day 1: Docetaxel 75mg/m2 IV over 60 minutes, followed by: Day 1: Carboplatin AUC 6 IV over 30 minutes. Repeat cycle every 3 weeks for 4—6 cycles. |
Carboplatin + Gemcitabine (Category 1)93 |
Days 1,8,15: Gemcitabine 1,000mg/m2 IV over 30 minutes Day 1: Carboplatin AUC 5 IV over 30 minutes. Repeat cycle ever 4 weeks for 4-6 cycles. |
Carboplatin + Paclitaxel (Category 1)94 |
Day 1: Paclitaxel 200mg/m2 IV over 3 hours, followed by: Day 1: Carboplatin AUC 6 IV over 30 minutes. Repeat cycle every 3 weeks for 4-6 cycles. |
Cisplatin + Docetaxel (Category 1)90 |
Day 1: Docetaxel 75mg/m2 IV over 60 minutes, followed by: Day 1: Cisplatin 75mg/m2 over 60 minutes. Repeat cycle every 3 weeks for 4-6 cycles. |
Cisplatin + Etoposide (Category 1)96 |
Day 1: Cisplatin 100mg/m2 over 60 minutes Days 1-3: Etoposide 100mg/m2 IV over 60 minutes. Repeat cycle every 3 weeks for 4-6 cycles. |
Cisplatin + Gemcitabine (Category 1)97,98 |
Days 1 and 8: Gemcitabine 1,000-1,250mg/m2 IV over 30 minutes, followed by: Day 1: Cisplatin 75-80mg/m2 IV over 60 minutes. Repeat cycle every 3 weeks for 4-6 cycles. |
Cisplatin + Paclitaxel (Category 1)99 |
Day 1: Paclitaxel 135mg/m2 IV over 3 hours, followed by: Day 1: Cisplatin 75mg/m2 IV over 60 minutes. Repeat every 3 weeks for 4-6 cycles. |
Gemcitabine + Docetaxel (Category 1)101 |
Day 1: Gemcitabine 1,000mg/m2 IV over 30 minutes Day 8: Docetaxel 85mg/m2 IV over 30 minutes, followed by: Day 8: Gemcitabine 1,000mg/m2 IV over 30 minutes. Repeat every 3 weeks for 4-6 weeks. |
Gemcitabine + Vinorelbine (Category 1)102 |
Days 1 and 8: Vinorelbine 25mg/m2 IV over 5-10 minutes Day 1 and 8: Gemcitabine 1,000mg/m2 IV over 30 minutes. Repeat cycle every 3 weeks for 4-6 cycles. |
Squamous Cell Carcinoma (PS 2): Initial Systemic Therapyp-r,t |
|
Preferred |
|
Carboplatin + Albumin-Bound Paclitaxel89 |
Days 1,8,15: Albumin-bound Paclitaxel 100mg/m2 IV over 30 minutes Day 1: Carboplatin AUC 6 IV over 30 minutes. Repeat cycle every 3 weeks for 4-6 cycles. |
Carboplatin + Gemcitabine93 |
Days 1,8,15: Gemcitabine 1,000mg/m2 IV over 30 minutes Day 1: Carboplatin AUC 5 IV over 30 minutes. Repeat cycle ever 4 weeks for 4-6 cycles. |
Carboplatin + Paclitaxel94 |
Day 1: Paclitaxel 200mg/m2 IV over 3 hours, followed by: Day 1: Carboplatin AUC 6 IV over 30 minutes. Repeat cycle every 3 weeks for 4-6 cycles. |
Other Recommended Regimens |
|
Carboplatin + Docetaxel90 |
Day 1: Docetaxel 75mg/m2 IV over 60 minutes, followed by: Day 1: Carboplatin AUC 6 IV over 30 minutes. Repeat cycle every 3 weeks for 4—6 cycles. |
Carboplatin + Etoposide91,92 |
Days 1-3: Etoposide 100mg/m2 IV over 30 minutes daily Day 1: Carboplatin AUC 5 IV over 30 minutes. Repeat cycle every 3 weeks for 4-6 cycles. |
Useful in Certain Circumstances |
|
Albumin-Bound Paclitaxel103,104 |
Day 1: Albumin-bound Paclitaxel 260mg/m2 IV over 30 minutes. Repeat cycle every 3 weeks for 4-6 cycles. OR Days 1, 8, 15: Albumin-bound Paclitaxel 125mg/m2 IV over 30 minutes. Repeat cycle every 4 weeks for 4-6 cycles. |
Docetaxel105,106 |
Day 1: Docetaxel 75mg/m2 IV over 60 minutes. Repeat cycle every 3 weeks for 4-6 cycles. |
Gemcitabine98,107,108 |
Days 1,8,15: Gemcitabine 1,000-1,250mg/m2 IV over 30 minutes. Repeat cycle every 4 weeks for 4-6 cycles. OR Days 1 and 8: Gemcitabine 1,250mg/m2 IV over 30 minutes. Repeat cycle every 3 weeks for 4-6 cycles. |
Gemcitabine + Docetaxel101 |
Day 1: Gemcitabine 1,000mg/m2 IV over 30 minutes Day 8: Docetaxel 85mg/m2 IV over 60 minutes, followed by: Day 8: Gemcitabine 1,000mg/m2 IV over 30 minutes. Repeat cycle every 3 weeks for 4-6 weeks. |
Gemcitabine + Vinorelbine101 |
Days 1 and 8: Vinorelbine 25mg/m2 IV over 5-10 minutes Days 1 and 8: Gemcitabine 1,000mg/m2 IV over 30 minutes. Repeat every 3 weeks for 4-6 cycles. |
Paclitaxel109-111 |
Day 1: Paclitaxel 200-225mg/m2 IV over 3 hours. Repeat cycle every 3 weeks for 4-6 cycles. OR Days 1,8,15: Paclitaxel 80mg/m2 IV over 60 minutes. Repeat cycle every 4 weeks for 4-6 cycles. |
Squamous Cell Carcinoma (PS 0-2): Continuation Maintenance |
|
Gemcitabine (Category 2B)98,107,108 |
Days 1,8,15: Gemcitabine 1,000-1,250mg/m2 IV over 30 minutes. Repeat cycle every 4 weeks. OR Days 1 and 8: Gemcitabine 1,250mg/m2 IV over 30 minutes. Repeat cycle every 3 weeks. |
Pembrolizumab75-79 |
Day 1: Pembrolizumab 200mg IV over 30 minutes. Repeat cycle every 3 weeks for up to 2 years of therapy. OR Day 1: Pembrolizumab 400mg IV over 30 minutes. Repeat cycle every 42 days for up to 2 years of therapy. |
Squamous Cell Carcinoma (PS 0-2): Switch Maintenance |
|
Docetaxel (Category 2B)105,106 |
Day 1: Docetaxel 75mg/m2 IV over 60 minutes. Repeat cycle every 3 weeks. |
Squamous Cell Carcinoma (PS 0-2): Subsequent Therapy |
|
Preferred (No Previous Immunotherapy) |
|
Atezolizumab (Category 1)70-72 |
Day 1: Atezolizumab 1,200mg IV. Repeat cycle every 3 weeks. OR Day 1: Atezolizumab 840mg IV. Repeat cycle every 2 weeks. OR Day 1: Atezolizumab 1,680mg IV. Repeat cycle every 4 weeks. |
Nivolumab (Category 1)81,115-118 |
Day 1: Nivolumab 240mg IV over 30 minutes. Repeat cycle every 2 weeks. OR Day 1: Nivolumab 480mg IV over 30 minutes. Repeat cycle every 4 weeks. |
Pembrolizumab (Category 1)75-79 |
Day 1: Pembrolizumab 200mg IV over 30 minutes. Repeat cycle every 3 weeks for up to 2 years of therapy. OR Day 1: Pembrolizumab 400mg IV over 30 minutes. Repeat cycle every 42 days for up to 2 years of therapy. |
Other Recommended Regimens (No Previous or Previous Immunotherapy) |
|
Docetaxel105,106 |
Day 1: Docetaxel 75mg/m2 IV over 60 minutes. Repeat cycle every 3 weeks. |
Gemcitabine98,107,108 |
Days 1,8,15: Gemcitabine 1,000-1,250mg/m2 IV over 30 minutes. Repeat cycle every 4 weeks. OR Days 1 and 8: Gemcitabine 1,250mg/m2 IV over 30 minutes. Repeat cycle every 3 weeks. |
Ramucirumab + Docetaxel17,119 |
Day 1: Ramucirumab 10mg/kg IV over 60 minutes Day 1: Docetaxel 75mg/m2 IV over 60 minutes. Repeat cycle every 3 weeks. |
▶Chemotherapy Regimens for Neoadjuvant and Adjuvant Therapy1,u,v |
|
REGIMEN |
DOSING |
Preferred (Nonsquamous) |
|
Cisplatin + Pemetrexed97,100 |
Day 1: Pemetrexed 500mg/m2 IV over 10 minutes Day 1: Cisplatin 75mg/m2 IV over 2 hours. Repeat cycle every 3 weeks for 4 cycles. |
Preferred (Squamous) |
|
Cisplatin + Gemcitabine97,98 |
Days 1,8: Gemcitabine 1,250mg/m2 IV over 30 minutes, followed by: Day 1: Cisplatin 75mg/m2 IV over 2 hours. Repeat cycle every 3 weeks for 4 cycles. |
Cisplatin + Docetaxel90 |
Day 1: Docetaxel 75mg/m2 IV over 60 minutes, followed by: Day 1: Cisplatin 75mg/m2 over 2 hours. Repeat cycle every 3 weeks for 4 cycles. |
Other Recommended Regimens |
|
Cisplatin + Etoposide120 |
Day 1: Cisplatin 100mg/m2 IV over 60 minutes Days 1-3: Etoposide 100mg/m2 IV over 2 hours. Repeat cycle every 4 weeks for 4 cycles. |
Cisplatin + Vinorelbine120-122 |
Day 1: Cisplatin 75-80mg/m2 IV over 60 minutes Days 1 and 8: Vinorelbine 25-30mg/m2 IV over 5-10 minutes. Repeat cycle every 3 weeks for 4 cycles. OR Days 1 and 8: Cisplatin 50mg/m2 IV over 60 minutes Days 1,8,15,22: Vinorelbine 25mg/m2 IV over 5-10 minutes. Repeat cycle every 4 weeks for 4 cycles. OR Day 1: Cisplatin 100mg/m2 over 60 minutes Days 1,8,15,22: Vinorelbine 30mg/m2 IV over 5-10 minutes. Repeat cycle every 4 weeks for 4 cycles. |
Useful in Certain Circumstances |
|
Chemotherapy Regimens for Patients With Comorbidities or Patients Not Able to Tolerate Cisplatin |
|
Carboplatin + Gemcitabine123 |
Days 1 and 8: Gemcitabine 1,000mg/m2 IV over 30 minutes Day 1: Carboplatin AUC 5 IV over 30 minutes. Repeat cycle every 3 weeks for 4 cycles. |
Carboplatin + Paclitaxel94,124 |
Day 1: Paclitaxel 200mg/m2 IV over 3 hours, followed by: Day 1: Carboplatin AUC 6 IV over 30 minutes. Repeat cycle every 3 weeks for 4 cycles. |
Carboplatin + Pemetrexed125 (non-squamous) |
Day 1: Pemetrexed 500mg/m2 IV over 10 minutes Day 1: Carboplatin AUC 5 IV over 30 minutes. Repeat cycle every 3 weeks for 4 cycles. |
▶Chemotherapy Regimens Used With Radiation Therapy (RT)1,w |
|
Concurrent Chemotherapy/RT Regimens |
|
Preferred (Nonsquamous) |
|
Carboplatin + Paclitaxel126,127,x-z |
Day 1: Paclitaxel 45-50mg/m2 IV over 60 minutes, followed by: Day 1: Carboplatin AUC 2 IV over 30 minutes. Repeat induction therapy weekly for 7 weeks with radiation. |
Carboplatin + Paclitaxel126,127,y,aa |
Day 1: Paclitaxel 45-50mg/m2 IV over 60 minutes, followed by: Day 1: Carboplatin AUC 2 IV over 30 minutes. Repeat induction therapy weekly for 7 weeks with radiation, conditionally followed by: Day 1: Paclitaxel 200mg/m2 IV over 3 hours Day 1: Carboplatin AUC 6 IV over 30 minutes. Repeat consolidation therapy every 3 weeks for 2 cycles starting 2-4 weeks after completion of concurrent chemoradiation. |
Carboplatin + Pemetrexed114,x-z |
Day 1: Carboplatin AUC 5 IV over 30 minutes Day 1: Pemetrexed 500mg/m2 IV over 10 minutes. Repeat cycle every 3 weeks for 4 cycles with radiation. |
Cisplatin + Etoposide128,129,x-z |
Days 1 and 8: Cisplatin 50mg/m2 IV over 60 minutes Days 1-5: Etoposide 50mg/m2 IV over 60 minutes. Repeat cycle every 4 weeks for 2 cycles with radiation. |
Cisplatin + Pemetrexed129,130, x-z |
Day 1: Pemetrexed 500mg/m2 IV over 10 minutes Day 1: Cisplatin 75mg/m2 IV over 2 hours. Repeat induction therapy every 3 weeks for 3 cycles with radiation, |
Cisplatin + Pemetrexed130,131,y,aa |
Day 1: Pemetrexed 500mg/m2 IV over 10 minutes Day 1: Cisplatin 75mg/m2 IV over 60 minutes. Repeat induction therapy every 3 weeks for 3 cycles with radiation, conditionally followed by: Day 1: Pemetrexed 500mg/m2 over 10 minutes. Repeat consolidation therapy every 3 weeks for 4 cycles following concurrent chemotherapy/radiation. |
Preferred (Squamous) |
|
Carboplatin + Paclitaxel126,127,x-z |
Day 1: Paclitaxel 45-50mg/m2 IV over 60 minutes, followed by: Day 1: Carboplatin AUC 2 IV over 30 minutes. Repeat induction therapy weekly for 7 weeks with radiation. |
Carboplatin + Paclitaxel126,127,y,aa |
Day 1: Paclitaxel 45-50mg/m2 IV over 60 minutes, followed by: Day 1: Carboplatin AUC 2 IV over 30 minutes. Repeat induction therapy weekly for 7 weeks with radiation, conditionally followed by: Day 1: Paclitaxel 200mg/m2 IV over 3 hours Day 1: Carboplatin AUC 6 IV over 30 minutes. Repeat consolidation therapy every 3 weeks for 2 cycles starting 2-4 weeks after completion of concurrent chemoradiation. |
Cisplatin + Etoposide128,129,x-z |
Days 1 and 8: Cisplatin 50mg/m2 IV over 60 minutes Days 1-5: Etoposide 50mg/m2 IV over 60 minutes. Repeat cycle every 4 weeks for 2 cycles with radiation. |
▶Consolidation Therapy for Patients With Unresectable Stage III NSCLC, PS 0-1, and No Disease Progression After 2 or More Cycles of Definitive ChemoRT1 |
|
Note: For patients with unresectable stage III NSCLC, PS 0-1, and no disease progression after 2 or more cycles of definitive chemoradiation. |
|
Durvalumab (Category 1)132-134, z,aa,bb |
Day 1: Durvalumab 10mg/kg IV over 60 minutes. Repeat cycle every 2 weeks for a maximum of 12 months. |
a For performance status 0-4. b If systemic therapy regimen contains an immune checkpoint inhibitor, physicians should be aware of the long half-life of such drugs and data reporting adverse events when combining checkpoint inhibitors with osimertinib. Schoenfeld AJ, Arbour KC, Rizvi H, et al. Severe immune-related adverse events are common with sequential PD(L)-1 blockade and osimertinib. Ann Oncol. 2019;30:839-844; Oshima Y, Tanimoto T, Yuji K, Tojo A. EGFR-TKI-associated interstitial pneumonitis in nivolumab-treated patients with non-small cell lung cancer. JAMA Oncol. 2018;3:1112-1115. Ahn M-J, Yang J, Yu H, et al. Results from TATTON phase 1b trial. J Thorac Oncol. 2016;11:S115 (abstr. 1360). c If EGFR mutation discovered during first-line systemic therapy, complete planned systemic therapy, including maintenance therapy or interrupt, followed by Osimertinib (preferred) or Erlotinib or Afatinib or Gefitinib or Dacomitanib or Erlotinib + Ramucirumab or Erlotinib + Bevacizumab (Category 2B). d Criteria for treatment with bevacizumab, non-squamous NSCLC, and no recent history of hemoptysis. Bevacizumab should not be given as a single agent. An FDA-approved biosimilar is an appropriate substitute for bevacizumab. e If ALK rearrangement discovered during first-line systemic therapy, complete planned systemic therapy, including maintenance therapy or interrupt followed by Alectinib (preferred) or Brigatinib or Ceritinib, or Crizotinb. f If ROS1 rearrangement discovered during first-line systemic therapy, complete planned systemic therapy, including maintenance therapy, or interrupt, followed by Crizotinib (preferred) or Entrectinib (preferred) or Ceritinib. g If BRAF V600E mutation discovered during first-line systemic therapy, complete planned systemic therapy, including maintenance therapy, or interrupt, followed by Dabrafenib + Trametinib. h Single-agent vemurafenib or dabrafenib are treatment options if the combination of Dabrafenib + Trametinib is not tolerated. i If NTRK gene fusion discovered during first-line systemic therapy, complete planned systemic therapy, including maintenance therapy, or interrupt, followed by Larotrectinib or Entrectinib. j If MET exon 14 skipping mutation discovered during first-line systemic therapy, complete planned systemic therapy, including maintenance therapy, or interrupt, followed by Capmatinib or Crizotinib. k If RET rearrangement discovered during first-line systemic therapy, complete planned systemic therapy, including maintenance therapy, or interrupt, followed by Selpercatinib (preferred) or Pralsetinib (preferred) or Cabozantinib or Vandetanib (Category 2B). l See Atezolizumab, Atezolizumab + Bevacizumab (Category 1), Pembrolizumab (Category 1), or Pembrolizumab + Pemetrexed (Category 1) continuation maintenance if response or stable disease. m See Pembrolizumab (Category 1) or Atezolizumab continuation maintenance if response or stable disease. n See Pembrolizumab (Category 1), Pembrolizumab + Pemetrexed (Category 1), Atezolizumab + Bevaciumab (Category 1), or Atezolizumab continuation if response or stable disease. o See Pembrolizumab continuation maintenance if response or stable disease. p Albumin-bound paclitaxel may be substituted for either paclitaxel or docetaxel in patients who have experienced hypersensitivity reactions after receiving paclitaxel or docetaxel despite premedication, or for patients where the standard premedications (ie, dexamethasone, H2 blockers, H1 blockers) are contraindicated. q Carboplatin-based regimens are often used for patients with comorbidities or those who cannot tolerate cisplatin. r If progression on a PD-1/PD-L1 inhibitor, switching to another PD-1/PD-L1 inhibitor is not routinely recommended. s See Bevacizumab (Category 1), Pemetrexed (Category 1), Bevacizumab + Pemetrexed, Pembrolizumab + Pemetrexed (Category 1), Atezolizumab + Bevacizumab (Category 1), Atezolizumab, or Gemcitabine (Category 2B) continuation maintenance or Pemetrexed switch maintenance if response or stable disease. t See Pembrolizumab, Gemcitabine (Category 2B), continuation maintenance or Docetaxel (Category 2B) switch maintenance if response or stable disease. u After surgical evaluation, patients likely to receive adjuvant chemotherapy may be treated with induction chemotherapy as an alternative. v All regimens can be used for sequential chemotherapy/RT. w Concurrent chemotherapy/RT is recommended for patients with inoperable stage II (node-positive) and stage III NSCLC. Sequential chemotherapy/RT or RT alone is appropriate for frail patients unable to tolerate concurrent therapy. x Regimen can be used as preoperative/adjuvant chemotherapy/RT. y Regimen can used as definitive concurrent chemotherapy RT. z For eligible patients, durvalumab may be used after noted concurrent chemo/RT regimens. aa If using durvalumab, an additional 2 cycles of chemotherapy is not recommended, if patients have not received full-dose chemotherapy concurrent with RT. bb Durvalumab is not recommended for patients following definitive surgical resection. |
|
References |
|
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