21
Palliative
Cytotoxic
Chemotherapy
and/or Radiation
Best Supportive
Care/Hospice
Consider
consolidative
therapy as
feasible**
Other tumor genetics?
e.g., ALK, NTRK or RET
fusions
N
N
Y
Y
or
or
Favorable tumor
response?
Checkpoint inhibitor
e.g., pembrolizumab, etc.
1
Targeted therapy
(e.g., fusions, ALK: crizotinib,
ceritinib, alectinib;
RET: pralsetinib, selpercatinib;
NTRK: larotrectinib,
entrectinib)
1
1
Additional agents exist and are in development, listings not meant to be comprehensive; clinical
trials preferred if available; see text.
** Consolidate Rx refers to focal therapy intended to control residual macro-metastatic disease
among those electing aggressive therapy. TMB, tumor mutational burden. Dashed arrows depict
circumstances where competing therapeutic options may be of consideration.
