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

91 NCCN Guidelines for Patients ® : Lung Cancer – Non-Small Cell, 2018 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 Nivolumab, pembrolizumab, and atezolizumab are preferred by NCCN experts over other options. 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 your performance score is 3 or 4, most drugs for lung cancer are likely to seriously harm your health. Thus, best supportive care is advised. Review † † For stage IV cancers, supportive care may enhance and extend life. Ask your treatment team for a supportive care plan. † † Metastatic cancer should be tested for mutations. If a mutation is present, first-line treatment consists of targeted therapy. First- line pembrolizumab may be used to treat lung cancers that are PD-L1 positive ≥50%. † † If you are healthy enough, metastatic disease with no known mutations is first treated with chemotherapy. Bevacizumab or pembrolizumab may be added for adenocarcinoma, large cell, and unknown subtypes. If the cancer worsens, nivolumab, pembrolizumab, and atezolizumab are preferred treatment options. If you are unhealthy, supportive care is an option. † † Clinical trials are an option for all metastatic disease. Ask your treatment team if there is a clinical trial you can join. Also ask about the pros and cons of the trial. 7 Metastatic cancer Review

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