What are the treatment options for non–small cell lung cancer (NSCLC) by stage?

Updated: Jul 15, 2021
  • Author: Winston W Tan, MD, FACP; Chief Editor: Nagla Abdel Karim, MD, PhD  more...
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Answer

Treatment of NSCLC by stage is as follows:

  • Stage IA - Surgery only; no adjuvant chemotherapy
  • Stage IB-IIIA - Surgery followed by adjuvant chemotherapy with four cycles of a cisplatin-based regimen and, in cases with an  EGFR  exon 19 deletion or exon 21 L858R mutation, adjuvant osimertinib
  • Stage II-IIIB - If surgically unresectable, chemoradiation plus durvalumab for one year if chemoradiation results in a partial or complete response 
  • Stage IV - Treat on the basis of histology (squamous or non-squamous)

Treatment of stage IV squamous NSCLC is as follows:

  • Cisplatin-based chemotherapy
  • If programmed death ligand 1 (PD-L1) expression is 1-49%, chemotherapy plus pembrolizumab
  • If PD-L1 expression is > 50%, pembrolizumab alone

Treatment of stage IV non-squamous NSCLC is as follows:

  • If PD-L1 expression is 1-49%, cisplatin-based chemotherapy plus pembrolizumab
  • If PD-L1 expression is > 50%, pembrolizumab alone
  • Cisplatin-based chemotherapy plus bevacizumab is also a reasonable option
  • Oral tyrosine kinase inhibitor or other targeted therapy for tumors with treatable driver mutations (eg,  EGFR, ALK, ROS1, RET, BRAF,  NTRK gene fusion,  MET exon 14 skipping; see  Workup/Molecular Testing)

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