Non-Small Cell Lung Cancer Treatment Regimens

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Non-Small Cell Lung Cancer Treatment Regimens

Clinical Trials: The NCCN recommends cancer patient participation in clinical trials as the gold standard for treatment.

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.

Note: All recommendations are category 2A unless otherwise indicated.

▶Systemic Therapy for Advanced or Metastatic Disease1

REGIMEN

DOSING

Sensitizing EGFR Mutation Positive: First-Line

Afatinib (Category 1)2-4

Afatinib 40mg orally once daily.

Erlotinib (Category 1)5-8

Erlotinb 150mg orally once daily.

Dacomitinib (Category 1)9,10

Dacomitinib 45mg orally once daily.

Gefitinib (Category 1)11,12

Gefitinib 250mg orally once daily.

Osimertinib (Category 1; preferred)13-16

Osimertinib 80mg orally once daily.

Sensitizing EGFR Mutation Positive: Subsequent Therapy

Afatinib + Cetuximab (if T790M-)2,17-18

Days 1-14: Afatinib 40mg orally once daily

Day 1: Cetuximab 500mg/m2 IV.

Repeat cycle every 2 weeks.

Osimertinib (if T790M+) (Category 1, if not previously given)13-16

Osimertinib 80mg orally once daily.

ALK Rearrangement Positive: First-Line

Alectinib (Category 1; preferred)19.20

Alectinib 600mg orally twice daily

Brigatinib (Category 1)21-23

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)24-28

Ceritinib 450mg orally once daily.

Crizotinib (Category 1)29-32

Crizotinib 250mg orally twice daily.

ALK Rearrangement Positive: Subsequent Therapy

Alectinib19,20

Alectinib 600mg orally twice daily

Brigantinib21-23

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.

Ceritinib24-28

Ceritinib 450mg orally once daily.

Lorlatinib33-35

Lorlatinib 100mg orally once daily.

ROS1 Rearrangement Positive: First-Line

Ceritinib24-28

Ceritinib 450mg orally once daily.

Crizotinib (preferred)29-32

Crizotinib 250mg orally twice daily.

Entrectinib (preferred)36,37

Entrectinib 600mg orally once daily.

ROS1 Rearrangement Positive: Subsequent Therapy

Lorlatinib33-35

Lorlatinib 100mg orally once daily.

BRAF V600E Mutation Positive: First-line and Subsequent Therapy

Dabrafenib38-40,a

Dabrafenib 150mg orally twice daily.

Dabrafenib + Trametinib38,41-43,a

Dabrafenib 150mg orally twice daily

Trametinib 2mg orally once daily.

Vemurafenib44-46,a

Vemurafenib 960mg orally twice daily.

NTRK Gene Fusion Positivec

Entrectinib36,37

Entrectinib 600mg orally once daily.

Larotrectinib47-49

Larotrectinib 100mg orally twice daily.

PD-L1 expression positive (≥1%) and EGFR, ALK negative or unknown, adenocarcinoma, large cell, NSCLC NOS: First-Lineb

Carboplatin + Paclitaxel + Bevacizumab + Atezolizumab (Category 1)50-53,c,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.d

Carboplatin + Pemetrexed + Pembrolizumab (Category 1 if PD-L1 ≥50%; category 1 and preferred if PD-L1 1-49%)53-55,e

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 if PD-L1 ≥50%; Category 1 and preferred if PD-L1 1-49%)53,54,e

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

Pembrolizumab (Category 1 and preferred if PD-L1 ≥50%; Category 2B is PD-L1 1-49%)53,56-58,f,g

Day 1: Pembrolizumab 200mg IV over 30 minutes.

Repeat cycle every 3 weeks for a total maximum of 35 cycles of Pembrolizumab.g

PD-L1 expression positive (≥1%) and EGFR, ALK negative or unknown, adenocarcinoma, large cell, NSCLC NOS: Continuation Maintenance Therapyb

Atezolizumab and/or Bevacizumab (Category 1)50-52, 59, 60,c

Day 1: Atezolizumab 1,200mg IV.

Repeat cycle every 3 weeks.

OR

Day 1: Atezolizumab 1,200mg IV

Day 1: Bevacizumab 15mg/kg IV.

Repeat cycle every 3 weeks.

OR

Bevacizumab 15mg/kg IV.

Repeat cycle every 3 weeks.

Pembrolizumab (Category 1)53,56-58

Day 1: Pembrolizumab 200mg IV over 30 minutes.

Repeat cycle every 3 weeks for a maximum total of 35 cycles of Pembrolizumab.

Pembrolizumab + Pemetrexed (Category 1)53-55

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

PD-L1 expression positive (≥1%) and EGFR, ALK negative or unknown, squamous cell carcinoma: First-Lineb

Carboplatin + Albumin-Bound Paclitaxel + Pembrolizumab (Category 1 if PD-L1 ≥50%; Category 1 and preferred if PD-L1 1-49%)53,61,g

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 if PD-L1 ≥50%; Category 1 and preferred if PD-L1 1-49%)53,61,g

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

Cisplatin + Albumin-Bound Paclitaxel + Pembrolizumab (Category 1 if PD-L1 ≥50%; Category 1 and preferred if PD-L1 1-49%)53,61-63,g

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: Cisplatin 75-80mg/m2 IV over 60 minutes.

Repeat cycle every 3 weeks for 4 cycles.g

Cisplatin + Paclitaxel + Pembrolizumab (Category 1 if PD-L1 ≥50%; Category 1 and preferred if PD-L1 1-49%)53,61-63,g

Day 1: Pembrolizumab 200mg IV over 30 minutes, followed by:

Day 1: Paclitaxel 200mg/m2 IV over 3 hours

Day 1: Cisplatin 75-80mg/m2 IV over 60 minutes.

Repeat cycle every 3 weeks for 4 cycles.g

Pembrolizumab (Category 1 and preferred if PD-L1 ≥50%; Category 2B is PD-L1 1-49%)53,56-58,f,g

Day 1: Pembrolizumab 200mg IV over 30 minutes.

Repeat cycle every 3 weeks for a maximum of 35 cycles.g

PD-L1 expression positive (≥1%) and EGFR, ALK negative or unknown, squamous cell carcinoma: Continuation Maintenanceb

Pembrolizumab53,56-58

Day 1: Pembrolizumab 200mg IV over 30 minutes.

Repeat every 3 weeks for a maximum total of 35 cycles of Pembrolizumab.

Adenocarcinoma, Large Cell, NSCLC, NOS (PS 0-1): Initial Therapyh-j

No contraindications to the addition of Pembrolizumab or Atezoliziumab

Atezolizumab + Carboplatin + Paclitaxel + Bevacizumab (Category 1)50-53,c,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.d

Pembrolizumab + Carboplatin + Pemetrexed (Category 1; preferred)53-55,e

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; preferred)53,54,e

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 every 3 weeks for 4-6 cycles.e

Contraindications to the addition of Pembrolizumab or Atezolizumab

Bevacizumab + Carboplatin + Paclitaxel (Category 1)51,64,c,k

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.k

Bevacizumab + Carboplatin + Pemetrexed51,65,c,l

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.l

Bevacizumab + Cisplatin + Pemetrexed51,66,c, l

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.l

Carboplatin + Albumin-bound Paclitaxel (Category 1)62

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)67

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)68,69

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)70,m

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.m

Carboplatin + Paclitaxel (Category 1)71,72

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)73,n

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.n

Cisplatin + Docetaxel (Category 1)67

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)74

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)71,75,m

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.m

Cisplatin + Paclitaxel (Category 1)66,71,75

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)75-77,n

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.n

Gemcitabine + Docetaxel (Category 1)78,m

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.m

Gemcitabine + Vinorelbine (Category 1)79,m

Days 1 and 8: Vinorelbine 25mg/m2 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.m

Adenocarcinoma, Large Cell, NSCLC, NOS (PS 2): Initial Therapyh-j

Albumin-bound Paclitaxel80,81

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.

Carboplatin + Albumin-bound Paclitaxel62

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 + Docetaxel67

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 + Etoposide68,69

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 + Gemcitabine70,m

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.m

Carboplatin + Paclitaxel71,72

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 + Pemetrexed73,n

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.n

Docetaxel82,83

Day 1: Docetaxel 75mg/mg IV over 60 minutes.

Repeat cycle every 3 weeks for 4-6 cycles.

Gemcitabine8,84,85,m

Days 1,8,15: Gemcitabine 1,000-1,250mg/m2 IV over 30 minutes.

Repeat cycle every 4 weeks for 4-6 cycles.m

OR

Days 1 and 8: Gemcitabine 1,250mg/m2 IV over 30 minutes.

Repeat cycle every 3 weeks for 4-6 cycles.m

Gemcitabine + Docetaxel78,m

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.m

Gemcitabine + Vinorelbine79,m

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.m

Paclitaxel86-88

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.

Pemetrexed89-91,n

Day 1: Pemetrexed 500mg/m2 IV over 10 minutes.

Repeat cycle every 3 weeks for 4-6 cycles.n

Adenocarcinoma, Large Cell, NSCLC, NOS (PS 0-2): Continuation Maintenance

Atezolizumab (Category 1)50,59,60

Day 1: Atezolizumab 1,200mg IV.

Repeat cycle every 3 weeks.

Atezolizumab and Bevacizumab (Category 1)50-52

Day 1: Atezolizumab 1,200mg IV

Day 1: Bevacizumab 15mg/kg IV.

Repeat cycle every 3 weeks.

Bevacizumab (Category 1)50,64,c

Day 1: Bevacizumab 15mg/kg IV.

Repeat cycle every 3 weeks.

Pemetrexed (Category 1)89-91

Day 1: Pemetrexed 500mg/m2 IV over 10 minutes.

Repeat every 3 weeks.

Bevacizumab + Pemetrexed51,65,66,c

Day 1: Pemetrexed 500mg/m2 IV over 10 minutes

Day 1: Bevacziumab 7.5-15mg/kg IV.

Repeat cycle every 3 weeks.

Pembrolizumab + Pemetrexed (Category 1)53-55

Day 1: Pembrolizumab 200mg IV over 30 minutes, followed by:

Day 1: Pemetrexed 500mg/m2 IV over 10 minutes

Repeat every 3 weeks until a total maximum of 35 cycles of Pembrolizumab has been completed, followed by:

Day 1: Pemetrexed 500mg/m2 IV over 10 minutes.

Repeat cycle every 3 weeks.

Gemcitabine (Category 2B)8,84,85

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.

Adenocarcinoma, Large Cell, NSCLC, NOS (PS 0-2): Switch Maintenance

Pemetrexed89-91

Day 1: Pemetrexed 500mg/m2 IV over 10 minutes.

Repeat cycle every 3 weeks.

Adenocarcinoma, Large Cell, NSCLC, NOS (PS 0-2): Subsequent Therapyj,o

Atezolizumab (Category 1)50,59,60

Day 1: Atezoliziumab 1,200mg IV.

Repeat cycle every 3 weeks.

Docetaxel82,83

Day 1: Docetaxel 75mg/m2 IV over 60 minutes.

Repeat every 3 weeks.

Gemcitabine8,84,85

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.

Nivolumab (Category 1)92,96

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)53,56-58

Day 1: Pembrolizumab 200mg IV over 30 minutes.

Repeat cycle every 3 weeks for a total maximum of 35 cycles of Pembrolizumab.

Pemetrexed89-91

Day 1: Pemetrexed 500mg/m2 IV over 10 minutes.

Repeat cycle every 3 weeks.

Ramucirumab + Docetaxel97,98

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 Therapyh-j

No contraindications to the addition of Pembrolizumab

Pembrolizumab + Carboplatin + Albumin-bound Paclitaxel (Category 1; preferred)53,61,g

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.g

Pembrolizumab + Carboplatin + Paclitaxel (Category 1; preferred)53,61, g

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.g

Pembrolizumab + Cisplatin + Albumin-bound Paclitaxel53,61-63,g

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: Cisplatin 75-80mg/m2 IV over 60 minutes.

Repeat cycle every 3 week for 4 cycles.g

Pembrolizumab + Cisplatin + Paclitaxel53,61,63,g

Day 1: Pembrolizumab 200mg IV over 30 minutes, followed by:

Day 1: Paclitaxel 200mg/m2 IV over 3 hours

Day 1: Cisplatin 75-80mg/m2 IV over 60 minutes.

Repeat cycle every 3 weeks for 4 cycles.g

Contraindications to the addition of Pembrolizumab

Carboplatin + Albumin-bound Paclitaxel (Category 1)62

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)67

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)70,m

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.m

Carboplatin + Paclitaxel (Category 1)71,72

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)67

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)74

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)8,71,75,m

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.m

Cisplatin + Paclitaxel (Category 1)66,71,75

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)78

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)79,m

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.m

Squamous Cell Carcinoma (PS 2): Initial Therapyh-j

Albumin-bound Paclitaxel80,81

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.

Carboplatin + Albumin-bound Paclitaxel62

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 + Docetaxel67

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 + Etoposide69

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 + Paclitaxel71,73

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.

Docetaxel82,83

Day 1: Docetaxel 75mg/m2 IV over 60 minutes.

Repeat cycle every 3 weeks for 4-6 cycles.

Gemcitabine8,84,85,m

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.m

Gemcitabine + Docetaxel78,m

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.m

Gemcitabine + Vinorelbine79,m

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.m

Paclitaxel86-88

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)8,84,86

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.

Pembrolizumab53,56,58

Day 1: Pembrolizumab 200mg IV over 30 minutes.

Repeat cycle every 3 weeks for a maximum total of 35 weeks of Pemborlizumab.

Squamous Cell Carcinoma (PS 0-2): Switch Maintenance

Docetaxel (Category 2B)82,83

Day 1: Docetaxel 75mg/m2 IV over 60 minutes.

Repeat cycle every 3 weeks.

Squamous Cell Carcinoma (PS 0-2): Subsequent Therapyj,o

Atezolizumab (Category 1)50,59,60

Day 1: Atezolizumab 1,200mg IV.

Repeat cycle every 3 weeks.

Docetaxel82,83

Day 1: Docetaxel 75mg/m2 IV over 60 minutes.

Repeat cycle every 3 weeks.

Gemcitabine8,84,85

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.

Nivolumab (Category 1)92-96

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)53,56-58

Day 1: Pembrolizumab 200mg IV over 30 minutes.

Repeat cycle every 3 weeks for a total maximum of 35 cycles of Pembrolizumab.

Ramucirumab + Docetaxel97,98

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,p,q

REGIMEN

DOSING

Cisplatin + Docetaxel67

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 cycles.

Cisplatin + Etoposide99

Day 1: Cisplatin 100mg/m2 IV over 60 minutes

Days 1-3: Etoposide 100mg/m2 IV over 60 minutes.

Repeat cycle every 4 weeks for 4 cycles.

Cisplatin + Gemcitabine8,75

Days 1,8: Gemcitabine 1,250mg/m2 IV over 30 minutes, followed by:

Day 1: Cisplatin 75mg/m2 IV over 60 minutes.

Repeat cycle every 3 weeks for 4 cycles.

Cisplatin + Pemetrexed (nonsquamous)75,100

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 cycles.

Cisplatin + Vinorelbine99,101-103

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.

For patients with comorbidities or patients not able to tolerate cisplatin

Carboplatin + Gemcitabine100

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 + Paclitaxel71,72

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 + Pemetrexed (nonsquamous)104

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,r

REGIMEN

DOSING

Carboplatin + Paclitaxel105

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, 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 3-4 weeks after completion of concurrent chemoradiation.

Carboplatin + Pemetrexed (nonsquamous)91

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 + Etoposide106,107

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 + Pemetrexed (nonsquamous)108

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, followed by:

Day 1: Pemetrexed 500mg/m2 over 10 minutes.

Repeat consolidation therapy every 3 weeks for 4 cycles following concurrent chemotherapy/radiation.

Cisplatin + Vinblastine109

Days 1 and 29: Cisplatin 100mg/m2 IV over 60 minutes

Days 1,8,15,22,29: Vinblastine 5mg/m2 IV over 5-10 minutes.

Administer for one 35-day cycle with radiation.

▶Consolidation Therapy1

Note: For patients with unresectable stage III NSCLC, PS 0-1, and no disease progression after 2 or more cycles of definitive chemoradiation.

REGIMEN

DOSING

Durvalumab (Category 1)110,111,s

Day 1: Durvalumab 10mg/kg IV over 60 minutes.

Repeat cycle every 2 weeks for a maximum of 12 months.

  a. Single-agent vemurafenib or dabrafenib are treatment options if the combination of dabrafenib + trametinib is not tolerated.

  b. No contraindications to the addition of pembrolizumab or atezolizumab.

  c. Criteria for treatment with bevacizumab, non-squamours 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.

  d. See atezolizumab and/or bevacizumab continuation maintenance if response or stable disease.

  e. See pembrolizumab + pemetrexed continuation maintenance if response or stable disease.

   f. Pembrolizumab monotherapy can be considered in PD-L1, 1-49%, in patients with poor PS, or other contraindications to combination therapy

  g. See pembrolizumab continuation maintenance therapy if response or stable disease.

  h. 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.

   i. Carboplatin-based regimens are often used for patients with comorbidities or those who cannot tolerate cisplatin.

   j. Upon disease progression, if patient has not received platinum-doublet chemotherapy, refer to initial therapy. If patient received platinum chemotherapy and antiPD-1/PD-L1, refer to subsequent therapy.

  k. See bevacizumab continuation maintenance therapy if response or stable disease.

   l. See pemetrexed, bevacizumab, or pemetrexed + bevacizumab continuation maintenance if response or stable disease.

m. See gemcitabine continuation maintenance therapy if response or stable disease.

  n. See pemetrexed continuation maintenance therapy if response or stable disease.

  o. If progression on a PD-1/PD-L1 inhibitor, switching to another PD-1/PD-L1 inhibitor is not routinely recommended.

  p. After surgical evaluation, patients likely to receive adjuvant chemotherapy may be treated with induction chemotherapy as an alternative.

  q. All regimens can be used for sequential chemotherapy/RT.

   r. 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.

   s. Durvalumab may be used after any of the concurrent chemo/RT regimens listed above for eligible patients.

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(Revised 10/2019) © 2019 Haymarket Media, Inc.

Lung Cancer Drug Monographs

Respiratory And Thoracic Cancers

ABRAXANE ALECENSA ALIMTA
AVASTIN BLEOMYCIN CYRAMZA
DOXORUBICIN HCL DOXORUBICIN HCL SOLUTION ETOPOPHOS
ETOPOSIDE CAPSULES GEMZAR GILOTRIF
HYCAMTIN HYCAMTIN CAPSULES IRESSA
KEYTRUDA METHOTREXATE FOR INJECTION METHOTREXATE INJECTION
MUSTARGEN NAVELBINE OPDIVO
PHOTOFRIN PORTRAZZA TAGRISSO
TARCEVA TAXOL TAXOTERE
TECENTRIQ TOPOSAR TREXALL
XALKORI ZYKADIA
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