7
B1. Second-line Therapy for Patients and PS 0–1
Squamous and Non-squamous and Negative/Unknown EGFR
mutation, ALK or ROS-1 Gene Rearrangement
➤ For patients who received first-line chemotherapy and have not
received prior immune checkpoint inhibitor therapy, clinicians
should use single-agent nivolumab, pembrolizumab, or atezolizumab
in patients with positive tumor PDL-1 expression (TPS ≥1%, 22C3
assay), in the absence of contraindications to immune checkpoint
therapy (Strong Recommendation; EB-B-H).
➤ For patients with negative or unknown tumor PDL-1 expression
(TPS <1%) who received first-line therapy chemotherapy, clinicians
should use single-agent nivolumab or atezolizumab in the absence
of contraindications to immune checkpoint therapy (Strong
Recommendation; EB-B-H).
➤ There are insufficient data to recommend combination checkpoint
inhibitors or immune checkpoint inhibitors with chemotherapy in the
second-line setting.
➤ For patients who received an immune checkpoint inhibitor as
first-line therapy, clinicians should offer standard platinum-
based chemotherapy as outlined in the 2015 update (Strong
Recommendation; EB-B-H), or nonplatinum based two-drug therapy
if platinum contraindicated as outlined in the 2015 update (Strong
Recommendation; IC-B-L).
➤ For patients with contraindications to immune checkpoint inhibitor
therapy after first-line chemotherapy, docetaxel is recommended as
second-line therapy (Moderate Recommendation; EB-B-I).
Non-squamous Only
➤ Patients with non-SCC who have not previously received pemetrexed-
based first-line or maintenance therapy should be offered pemetrexed
second-line (Strong Recommendation; EB-B-H).
• 5.1. (New) In addition to previously recommended regimens, for patients with
non-SCC who received an immune checkpoint inhibitor and chemotherapy as
first-line therapy, clinicians may offer paclitaxel plus bevacizumab in the second-
line setting (Weak Recommendation; L).
