Sequencing Therapy for Patients With Lung Cancer

Presenter: Gregory J. Riely
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Non–small cell lung cancer (NSCLC) can no longer be considered as one disease, nor can it be treated as one. Understanding tumor histology in NSCLC is critical to understanding optimal biomarker evaluation and initial therapy. Proper biomarker evaluation includes both evaluation of PD-L1 status, as well as testing for actionable oncogenic drivers such as EGFR, ALK, ROS1, BRAF, Met Exon 14, RET, and NTRK. For patients with NSCLC and a driver oncogene, preferred treatment is targeted therapy. Conversely, for those without an oncogenic driver, preferred initial treatment is pembrolizumab in combination with chemotherapy for patients with low PD-L1 expression (1%–49%) or as a single-agent for high PD-L1 expression (≥50%). For small cell lung cancer (SCLC), the first major NCCN Guideline changes occurred in 2019, with the addition of either atezolizumab or durvalumab to platinum-based chemotherapy and etoposide as first-line therapy for patients with extensive-stage SCLC.

Disclosures: Dr. Riely has disclosed that the has received grant/research support from Merck & Co., Inc.; Novartis Pharmaceuticals Corporation; Mirati Therapeutics Inc.; Pfizer Inc.; Roche Laboratories, Inc.; and Takeda Pharmaceuticals North America, Inc.

Correspondence: Gregory J. Riely, MD, PhD, Memorial Sloan Kettering Cancer Center, 530 East 74th Street, New York, NY 10021. Email: rielyg@mskcc.org
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