NCCN Guidelines for Patients® | Non-Small Cell Lung Cancer - page 78

78
NCCN Guidelines for Patients
®
: Non-Small Cell Lung Cancer
Version 1.2014
Part 7: Treatment by cancer stage
EGFR or ALK status: Positive
Symptoms present Tumor location Number
of tumors
Treatment options if cancer grows during
first-line treatments
No
Anywhere
Any
Stay on erlotinib or afatinib if EGFR mutation, or
Stay on crizotinib if ALK gene rearrangement
Yes
Brain
1
Consider local treatment and stay on targeted therapy
2 or more Consider WBRT and stay on targeted therapy
Anywhere (minus brain) 1
Consider local treatment and targeted therapy
2 or more Platinum-doublet chemotherapy ± bevacizumab
(± erlotinib if EGFR mutation)
This chart lists treatment options if the cancer grows during
first-line treatment for lung cancers with EGFR or ALK
gene changes. Treatment options are based on whether
the cancer is causing symptoms. If the cancer isn’t causing
symptoms, keep taking the first-line treatment given to
you.
If the cancer is causing symptoms, treatment options
are also based on where the cancer is in the body and
the number of tumors. Local treatment may be given if
only one new tumor has grown. You should also keep
taking the first-line targeted therapy—erlotinib, afatinib,
or crizotinib. If there are multiple tumors in your brain,
consider having WBRT to treat these tumors and stay on
first-line targeted therapy. Platinum-doublet chemotherapy
with or without bevacizumab is recommended if you have
two or more new tumors except for in the brain. Platinum-
doublet chemotherapy is a drug regimen that consists of
a chemotherapy drug made with platinum and the use of
another drug. Erlotinib may be added to this regimen if the
EGFR mutation is present.
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