ASCO GUIDELINES Bundle

NSCLC Stage IV without Driver Alterations

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6 Treatment Negative or Unknown PD-L1 Status (TPS 0%–49%), and PS 0–1 ➤ For patients with negative (TPS 0%, <1%, or unknown) and/or low positive (TPS 1%–49%) PD-L1 expression and SCC, in the absence of contraindications to immune checkpoint inhibitor therapies: • 4.1. Clinicians should offer pembrolizumab/carboplatin/(paclitaxel or nab- paclitaxel (Strong Recommendation; I). • 4.2. For patients who have the above characteristics AND with contraindications to immunotherapy AND not deemed candidates for platinum-based therapy, clinicians should offer standard chemotherapy with non-platinum-based two drug combinations as outlined in the 2015 update (Strong Recommendation; H). • 4.3. For patients with contraindications to immunotherapy AND not deemed candidates for platinum-based therapy, clinicians should offer standard chemotherapy with non-platinum-based two drug combinations as outlined in the 2015 update (Weak Recommendation; I). • 4.4. For patients with low positive PD-L1 (TPS 1%–49%) AND who are ineligible for or decline combination of doublet platinum/pembrolizumab AND have contraindications to doublet-chemotherapy, clinicians may offer single- agent pembrolizumab, in the absence of contraindications to immune checkpoint therapies (Weak Recommendation; L). • 4.5. In addition to 2020 recommendations 4.1–4.4, for patients with negative (TPS 0%) and low positive (TPS 1%–49%) PD-L1 expression, SCC, and PS 0–1, clinicians may offer nivolumab and ipilimumab alone or in combination with two cycles of platinum-based chemotherapy (Weak Recommendation; M). PS 2 a. In the context of shared decision making, combination chemotherapy, single-agent therapy, or palliative therapy alone may be used for patients with stage IV NSCLC, SCC, and PS2: • Chemotherapy (Weak Recommendation; EB-B-I). • Palliative care (Strong Recommendation; EB-B-I).

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