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

88 NCCN Guidelines for Patients ® : Lung Cancer – Non-Small Cell, 2018 Biomarkers not present or unknown This section lists treatments for when biomarkers are absent or unknown. These treatments may also be used as after first-line treatment for metastatic lung cancers with known biomarkers. Adenocarcinomas, large cell carcinomas, and unknown types Guide 26 lists treatment options for adenocarcinomas, large cell carcinomas, and unknown types. Treatment options are based on performance status. First-line treatment You may be treated with chemotherapy if your performance score is between 0 and 2. Your doctor will choose a regimen based on how well it will stop cancer growth compared to how harmful it could be. The use of two drugs is called doublet chemotherapy. It is an option if your performance score is 0 or 1. Another option is bevacizumab used with chemotherapy. To receive this treatment, you should not have a recent history of coughing up blood (hemoptysis). A third option is pembrolizumab and chemotherapy. After 2 cycles of chemotherapy, the cancer’s response to treatment will be tested. It will be tested again every 2 to 4 cycles. If there’s no cancer growth, a total of 4 to 6 chemotherapy cycles are advised. A performance score of 3 or 4 suggests that chemotherapy will be too harmful. Therefore, the best supportive care is advised. Supportive care aims to treat the symptoms caused by the cancer. Maintenance treatment First-line treatment may stop the cancer from getting worse. In this case, you may stay on some of your first-line treatments. This is called continuation maintenance. Another option is changing to a medicine that you didn’t take as a first-line treatment. This is called switch maintenance. A third option is to start close observation. Observation is a period of testing to watch changes in cancer status. Next-in-line treatment The cancer may worsen during or after first-line treatment. Treatment is based on performance status. Joining a clinical trial is always an option for lung cancer treatment. Ask your treatment team if there is a clinical trial you can join. Also ask about the pros and cons of the trial. Performance scores 0–2 For these scores, nivolumab, pembrolizumab, and atezolizumab are preferred by NCCN experts. Pembrolizumab is approved for lung cancers that are PD-L1 positive. Other options include regimens with chemotherapy. Do not take the chemotherapy drugs listed if you’ve had them before. Performance scores 3–4 If these scores, most cancer drugs are likely to seriously harm your health. Thus, best supportive care is advised. 7 Metastatic cancer Biomarkers not present or unknown

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