Lung Cancer, non small lung cancer (NSCLC)
Compliance rules
1Summary
Lung cancer is the third most frequent malignancy in women and the second most frequent malignancy in men. The median age at diagnosis is between 68 and 70 years. Major risk factor is smoking.
Screening of asymptomatic high-risk persons via low-dose computer tomography (LDCT) can identify lung cancer in early stages. It reduces cancer-specific and overall mortality, especially in women.
Treatment of patients with lung cancer is paradigmatic for modern oncology. NSCLC can now be subdivided in more than a dozen biological entities with individual treatment concepts. Prognosis of patients is determined by stage, histology, immunohistochemistry, sex, ECOG status and comorbidity.
Treatment options include surgery, radiation and systemic treatment, often combined in multimodal concepts. Treatment in early stages and in some patients with advanced stage is curative. For patients in stage IIIB/IV the integration of immune checkpoint and of kinase inhibitors has significantly improved their prognosis.
2[Kapitel nicht relevant]
3[Kapitel nicht relevant]
4[Kapitel nicht relevant]
5[Kapitel nicht relevant]
6Therapy
6.1Therapeutic algorithm
6.1.1Primary therapy
Primary therapy is based on the criteria of the 8th lung cancer TNM classification and clinical staging system, see Figure 1.
1 clinical stages;
2 see figure
6.1.2Systemic therapy in advanced stages
Recommendations are based on predictive, histological, immunohistochemical and genetic markers, see Figure 2.
6.1.2.1Molecular genetic stratification of therapy
This chapter contains recommendations for targeted first- and second-line treatment, see Figure 3.
6.1.2.2No molecular genetic stratification of therapy
The majority of patients with NSCLC does not have predictive markers for molecular stratified therapy. Immunochemotherapy has become the standard of care in the first line treatment of these patients, see Figure 4.
6.2Facts and Appraisal
6.2.1Adjuvant therapy
6.2.1.1Adjuvant chemotherapy
Adjuvant chemotherapy is recommended in patients with stages II-IIIA after surgical R0 resection. Data are summarized in Figure 5 and Figure 6.
Publication: DOI:10.1016/S1470-2045(06)70804-X
Publication: DOI:10.1200/JCO.2009.23.2272
6.2.1.2Adjuvant immunotherapy
6.2.1.2.1Durvalumab, Stage III, after radiochemotherapy
Data are summarized in Figure 7.
Publication DOI:10.1056/NEJMoa1709937; DOI:10.1056/NEJMoa1809697
6.2.2Advanced stages
6.2.2.1Molecular genetic stratification
6.2.2.1.1ALK inhibitors
Data are summarized in Figure 8, Figure 9 and Figure 10.
Publication: DOI:10.1056/NEJMoa1704795
Publication: DOI:10.1016/S0140-6736(17)30123-X
Publication: DOI:10.1056/NEJMoa1408440; DOI:10.1200/JCO.2017.77.4794
Data are summarized in Figure 11, Figure 12, Figure 13 and Figure 14.
Publication: DOI:10.1093/annonc/mdy121
Publication: DOI:10.1200/JCO.2016.71.5904
Publication: DOI:10.1016/S1470-2045(17)30339-X
Publication: DOI:10.1056/NEJMoa1214886
6.2.2.1.2BRAF inhibitors, first and second line
Data are summarized in Figure 15 and Figure 16.
Publication: DOI:10.1016/S1470-2045(17)30679-4
Publication: DOI:10.1016/S1470-2045(16)30146-2
6.2.2.1.3EGFR inhibitors
Data are summarized in Figure 17, Figure 18, Figure 19, Figure 20, Figure 21 and Figure 22.
Publication: DOI:10.1016/S1470-2045(13)70604-1; DOI:10.1016/S1470-2045(15)00026-1; DOI:10.1016/j.cllc.2018.03.009
Publication: DOI:10.1016/S1470-2045(17)30608-3; DOI:10.1200/JCO.2018.78.7994
Publication: DOI:10.1016/S1470-2045(11)70393-X
Publication: DOI:10.1016/S1470-2045(11)70393-X
Publication: DOI:10.1056/NEJMoa0810699; DOI:10.1200/JCO.2010.33.4235
Publication: DOI:10.1056/NEJMoa1713137; DOI:10.1056/NEJMoa1913662
Data are summarized in Figure 23.
Publication: DOI:10.1056/NEJMoa1411817; DOI:10.1056/NEJMoa1612674
6.2.2.1.4ROS1 inhibitors
Data are summarized in Figure 24.
Publication: DOI:10.1056/NEJMoa1406766
Other kinase inhibitors like ceritinib, cabozantinib, entrectinib and lorlatinib show effectivity in ROS-1 translocated NSCLC, but are not approved in the EU.
6.2.2.2No molecular genetic stratification
6.2.2.2.1Chemotherapy
Cytostatic drugs are the backbone of systemic therapy in these patients. Data on the selection of platin derivates are summarized in Figure 25 and Figure 26, data on pemetrexed in Figure 27.
Publication: DOI:10.1002/14651858.CD009256.pub2
Publication: DOI:10.1016/j.lungcan.2019.07.010
Publication: DOI:10.1200/JCO.2007.15.0375
Data on docetaxel are summarized in Figure 28.
Publication: DOI:10.1200/JCO.2000.18.12.2354
6.2.2.2.2Immunotherapy
Immune checkpoint inhibitors are approved as monotherapy and in combination with chemotherapy.
Data are summarized in Figure 29.
Publication: DOI:10.1056/NEJMoa1606774
Data are summarized in Figure 30, Figure 31 and Figure 32.
Publication: DOI:10.1056/NEJMoa1716948
Publication: DOI:10.1056/NEJMoa1801005
Publication: DOI:10.1056/NEJMoa1810865
Data are summarized in Figure 33, Figure 34, Figure 35 and Figure 36.
Publication: DOI:10.1016/S0140-6736(16)32517-X
Publication: DOI:10.1056/NEJMoa1507643
Publication: DOI:10.1056/NEJMoa1507643
Publication: DOI:10.1016/S0140-6736(15)01281-7
6.2.2.2.3Others
Data are summarized in Figure 37.
Publication: DOI:10.1056/NEJMoa061884
Others including antiangiogenetic agents and tyrosine kinase inhibitors. Data are summarized in Figure 38, Figure 39, Figure 40 and Figure 41
Publication: DOI:10.1016/S1470-2045(15)00006-6
Publication: DOI:10.1056/NEJMoa050753
Publication: DOI:10.1016/S1470-2045(13)70586-2
Publication: DOI:10.1016/S0140-6736(14)60845-X
7[Kapitel nicht relevant]
8[Kapitel nicht relevant]
9[Kapitel nicht relevant]
10[Kapitel nicht relevant]
11[Kapitel nicht relevant]
12[Kapitel nicht relevant]
13[Kapitel nicht relevant]
15Disclosure of Potential Conflicts of Interest
according to the rules of the responsible Medical Societies.
Download
Reference:
Quellenangabe:
Onkopedia-Leitlinien werden kontinuierlich an den Stand des Wissens angepasst. Die jeweils gültige Version, AGB und Nutzungsbedingungen finden Sie unter www.onkopedia.com.
Für die kommerzielle Nutzung wenden Sie sich bitte an onkopedia@dgho.de.
Onkopedia guidelines are continuously adapted to the state of knowledge. The currently valid version, terms of use and general terms and conditions can be found at onkopedia-guidelines.info.
For commercial use, please contact onkopedia@dgho.de.
