ASCO GUIDELINES Bundle

NSCLC Stage IV without Driver Alterations

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9 Negative (TPS 0%) and low positive PD-L1 (TPS 1%–49%) High PD-L1 (TPS ≥50%) SCC a is does not apply to patients with stage IV NSCLC with rarer histologies, e.g., large cell neuroendocrine. Single-agent pembrolizumab S Single-agent atezolizumab S Single-agent cemiplimab S Single-agent pembrolizumab W Pembrolizumab/carboplatin/ paclitaxel or nab-paclitaxel S Nivolumab/ipililumab ± chemotherapy W Standard chemotherapy with platinum-based two-drug combinations S Standard chemotherapy with non-platinum-based two-drug combinations W Nivolumab/ipilimumab ± chemotherapy W Pembrolizumab/carboplatin/ paclitaxel or nab-paclitaxel M Treatment options Treatment options For patients with contraindications to immunotherapy For patients with contraindications to immunotherapy and are not candidates for platinum-based therapy For patients with low positive PD-L1 expression who are ineligible for doublet platinum ± pembrolizumab EGFR/ALK/ROS-1/BRAF positive Refer to algorithm for Stage IV NSCLC with Driver Alterations Strength of Recommendation W Strong Moderate Weak M S

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