ASCO GUIDELINES Bundle

NSCLC Stage IV without Driver Alterations

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5 PS 2 ➤ In the context of shared decision making, combination therapy, single agent therapy, or palliative therapy alone may be used for patients with the characteristics described in Clinical Question A3a: • Chemotherapy (Weak Recommendation; EB-B-I). • Palliative care (Strong Recommendation; EB-B-I). A3. High PD-L1 Status (TPS ≥50%), and PS 0–1 ➤ For patients with high PD-L1 expression (TPS ≥ 50%) SCC, PS 0–1, in the absence of contraindications to immune checkpoint inhibitor therapy: • 3.1. Clinicians should offer single-agent pembrolizumab (Strong Recommendation; H). • 3.2. Clinicians may offer pembrolizumab/carboplatin/(paclitaxel or nab- paclitaxel) (Moderate Recommendation; I). • 3.3. In addition to 2020 options, for patients with high PD-L1 expression (TPS ≥50%), SCC, and PS 0–1, clinicians may offer single-agent atezolizumab (Strong Recommendation; M). • 3.4. In addition to 2020 options, for patients with high PD-L1 expression (TPS ≥50%), SCC, and PS 0–1, clinicians may offer single-agent cemiplimab (Strong Recommendation; M). • 3.5. In addition to 2020 options, for patients with high PD-L1 expression (TPS ≥50%), SCC, and PS 0–1, clinicians may offer nivolumab and ipilimumab alone or nivolumab and ipilimumab plus two cycles of platinum-based chemotherapy (Weak Recommendation; M). • 3.6. (previously #3.3.) There are insufficient data to recommend any other checkpoint inhibitors or to recommend combination checkpoint inhibitors or any other combinations of ICIs with chemotherapy in the first-line setting (Strong Recommendation; H).

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