3
Treatment
A1. Chemotherapy
a. For patients with performance status (PS) of 0 or 1 receiving
chemotherapy, a combination of two cytotoxic drugs is recommended.
Platinum combinations are recommended over nonplatinum therapy.
However, nonplatinum therapy combinations are recommended for
patients who have contraindications to platinum therapy. Chemotherapy
may also be used to treat selected patients with PS of 2 who desire
aggressive treatment after a thorough discussion of the risks and
benefits of such treatment.
b. Because there is no cure for patients with stage IV NSCLC, early
concomitant palliative care assistance has improved the survival and
well-being of patients and is therefore recommended.
A2. First-line Therapy
a. For patients with high PD-L1/PD1 expression (TPS ≥50%), in the
absence of contraindications to immune checkpoint inhibitor therapies,
non-squamous cell carcinoma (SCC) PS 0–1:
• 1.1. Clinicians should offer single-agent pembrolizumab (Strong
Recommendation; H).
• 1.2. Clinicians may offer pembrolizumab/carboplatin/pemetrexed (Strong
Recommendation; H).
• 1.3. Clinicians may offer atezolizumab/carboplatin/paclitaxel/bevacizumab in
the absence of contraindications to bevacizumab (Moderate Recommendation; I).
• 1.4. Clinicians may offer atezolizumab/carboplatin/nab-paclitaxel (Weak
Recommendation; L).
• 1.5. In addition to 2020 options, for patients with high PD-L1 expression
(TPS ≥50%), non-SCC, and PS 0–1, clinicians may offer single-agent
atezolizumab (Strong Recommendation; M).
• 1.6. In addition to 2020 options, for patients with high PD-L1 expression
(TPS ≥50%), non-SCC, and PS 0–1, clinicians may offer single-agent
cemiplimab (Strong Recommendation; M).
• 1.7. In addition to 2020 options, for patients with high PD-L1 expression
(TPS ≥ 50%), non-SCC, and PS 0 to 1, clinicians may offer nivolumab and
ipilimumab alone or nivolumab and ipilimumab plus two cycles of platinum-
based chemotherapy (Weak Recommendation; M).
• 1.8. (previously #1.5.) 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).
