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ASCO指南更新:无驱动基因突变IV期非小细胞肺癌一线治疗!

2020-02-09 不详 网络

美国临床肿瘤学会(ASCO)于2017年发布了关于IV期非小细胞肺癌(NSCLC)系统治疗的临床实践指南。近日,ASCO指南部分更新,本次更新的目的是修订2017年ASCO指南中关于无驱动基因突变IV期NSCLC患者系统治疗的部分内容。2017年以来,这部分患者的治疗方案有了较大进展,本指南涵盖了免疫治疗、化疗和血管内皮生长因子抑制剂等治疗方案。本次更新主要基于5项III期随机临床试验,研究结

美国临床肿瘤学会(ASCO)于2017年发布了关于IV期非小细胞肺癌(NSCLC)系统治疗的临床实践指南。近日,ASCO指南部分更新,本次更新的目的是修订2017年ASCO指南中关于无驱动基因突变IV期NSCLC患者系统治疗的部分内容。2017年以来,这部分患者的治疗方案有了较大进展,本指南涵盖了免疫治疗、化疗和血管内皮生长因子抑制剂等治疗方案。本次更新主要基于5项III期随机临床试验,研究结果直接影响了相关临床问题。

问题

根据患者的组织亚型,无驱动基因突变IV期NSCLC患者的系统治疗选择是?

针对人群

无EGFR/ALK基因突变的IV 期NSCLC患者且PD-L1 TPS评分结果可用于临床。

推荐要点

对于PD-L1 TPS≥50%)的非鳞状NSCLC患者,在无免疫检查点治疗禁忌的情况下,一线治疗方案包括:

1.对于PD-L1高表达(PD-L1 TPS≥50%)的非鳞状NSCLC患者,体能状况(PS)评分为0~1,建议选择单药帕博利珠单抗(类型:基于证据;证据级别:高;推荐强度:强)。
2.对于PD-L1高表达(PD-L1 TPS≥50%)的非鳞状NSCLC、PS评分为0~1的患者,建议选择帕博利珠单抗+卡铂+培美曲塞(类型:基于证据;证据级别:高;推荐强度:强)。
3.对于PD-L1高表达(PD-L1 TPS≥50%)的非鳞状NSCLC患者、PS评分为0~1的患者,建议选择阿特珠单抗+卡铂+紫杉醇+贝伐珠单抗(类型:基于证据;证据级别:中;推荐强度:中)。
4.对于PD-L1高表达(PD-L1 TPS≥50%)的非鳞状NSCLC患者、PS评分为0~1的患者,建议选择阿特珠单抗+卡铂+白蛋白紫杉醇(类型:基于证据;证据级别:低;推荐强度:弱)。
5.目前没有充分证据推荐其他免疫检查点抑制剂单药或联合化疗用于这类患者的一线治疗(类型:基于证据;证据级别:高;推荐强度:高)。

对于PD-L1表达阴性(TPS 0%)和低表达(TPS 1%~49%)的非鳞状NSCLC患者,在无免疫检查点抑制剂治疗禁忌的情况下,一线治疗方案包括:

1. 对于PD-L1表达阴性(TPS 0%)和低表达(TPS 1%~49%)的非鳞状NSCLC、PS评分0~1、以及可接受化疗和帕博利珠单抗治疗的患者,建议选择帕博利珠单抗+卡铂+培美曲塞(类型:基于证据;证据级别:高;推荐强度:强)
2. 对于PD-L1表达阴性(TPS 0%)和低表达(TPS 1%~49%)的非鳞状NSCLC、PS评分0~1的患者,建议选择阿特珠单抗+卡铂+紫杉醇+贝伐珠单抗(类型:基于证据;证据级别:中;推荐强度:中)。
3. 对于PD-L1表达阴性(TPS 0%)和低表达(TPS 1%~49%)的非鳞状NSCLC、PS评分0~1的患者,建议选择阿特珠单抗+卡铂+白蛋白紫杉醇(类型:基于证据;证据级别:中;推荐强度:中)。
4. 对于PD-L1表达阴性(TPS 0%)和低表达(TPS 1%~49%)的非鳞状NSCLC、PS评分0~1、有免疫治疗禁忌症或拒绝免疫治疗的患者,建议选择含铂类双药化疗(类型:基于证据;证据级别:高;推荐强度:高)。
5. 对于PD-L1表达阴性(TPS 0%)和低表达(TPS 1%~49%)的非鳞状NSCLC、PS评分0~1、有免疫治疗禁忌症或拒绝免疫治疗以及不适合铂类化疗的患者,建议选择非铂类为基础的双药化疗(类型:基于证据;证据级别:中;推荐强度:弱)。
6. 对于PD-L1表达阴性(TPS 0%)和低表达(TPS 1%~49%)的非鳞状NSCLC、PS评分0~1,且不适合或拒绝铂类双药±帕博利珠单抗的患者,建议选择帕博利珠单抗单药(类型:基于证据;证据级别:低;推荐强度:弱)。

对于PD-L1高表达(TPS≥50%)的鳞状NSCLC患者,在无免疫检查点治疗禁忌症的情况下,治疗方案包括


1.对于PD-L1高表达(PD-L1 TPS≥50%)、PS评分为0~1的鳞状NSCLC患者,建议选择单药帕博利珠单抗(类型:基于证据;证据级别:高;推荐强度:强)。
2.对于PD-L1高表达(PD-L1 TPS≥50%)、PS评分为0~1的鳞状NSCLC患者,建议选择帕博利珠单抗+卡铂+紫杉醇或白蛋白紫杉醇(类型:基于证据;证据级别:中;推荐强度:强)。
3. 目前没有充分数据支持其他免疫检查点抑制剂单药或联合化疗用于该类患者的一线治疗(类型:基于证据;证据级别:高;推荐强度:强)。

对于PD-L1表达阴性(TPS 0%)和低表达(TPS 1%~49%)的鳞状NSCLC患者,在无免疫检查点抑制剂治疗禁忌症的情况下,一线治疗方案包括


1. 对于PD-L1表达阴性(TPS 0%)和低表达(TPS 1%~49%)、PS评分0~1的鳞状NSCLC患者,建议选择帕博利珠单抗+卡铂+紫杉醇或白蛋白紫杉醇(类型:基于证据;证据级别:中;推荐强度:强)。
2. 对于PD-L1表达阴性(TPS 0%)和低表达(TPS 1%~49%)、PS评分0~1的鳞状NSCLC患者,对免疫治疗有禁忌症的患者,建议选择铂类为基础的双药化疗(类型:基于证据;证据级别:高;推荐强度:强)。
3. 对于PD-L1表达阴性(TPS 0%)和低表达(TPS 1%~49%)、PS评分0~1的鳞状NSCLC患者,对免疫治疗有禁忌症且不适合铂类治疗的患者,建议选择非铂类的标准双药化疗(类型:基于证据;证据级别:中;推荐强度:弱)。
4. 在PD-L1表达阴性(TPS 0%)和低表达(TPS 1%~49%)、PS评分0~1的鳞状NSCLC患者中,对于不适合或拒绝含铂/帕博利珠单抗,以及对双药化疗有禁忌症的患者,建议选择帕博利珠单抗单药治疗(类型:基于证据;证据级别:低;推荐强度:弱)。



参考文献:

Hanna NH, Schneider BJ, Temin S, et al. Therapy for Stage IV Non-Small-Cell Lung Cancer Without Driver Alterations: ASCO and OH (CCO) Joint Guideline Update [published online ahead of print, 2020 Jan 28]. J Clin Oncol. 2020;JCO1903022. doi:10.1200/JCO.19.03022

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  5. [GetPortalCommentsPageByObjectIdResponse(id=1939025, encodeId=28851939025c3, content=<a href='/topic/show?id=1c292818fd' target=_blank style='color:#2F92EE;'>#ASC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=95, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2818, encryptionId=1c292818fd, topicName=ASC)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=74808, createdName=quxin068, createdTime=Thu Jul 16 12:49:00 CST 2020, time=2020-07-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2026457, encodeId=c19a202645e0a, content=<a href='/topic/show?id=53ff10150942' target=_blank style='color:#2F92EE;'>#驱动基因突变#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=83, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=101509, encryptionId=53ff10150942, topicName=驱动基因突变)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c6fc262, createdName=zhangmingxiang, createdTime=Tue Jun 16 15:49:00 CST 2020, time=2020-06-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1988271, encodeId=940919882e14a, content=<a href='/topic/show?id=327e563967e' target=_blank style='color:#2F92EE;'>#指南更新#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=107, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=56396, encryptionId=327e563967e, topicName=指南更新)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=04ce158, createdName=lxg951, createdTime=Wed May 06 16:49:00 CST 2020, time=2020-05-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2059871, encodeId=dab220598e183, content=<a href='/topic/show?id=2cc599381bd' target=_blank style='color:#2F92EE;'>#非小细胞#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=76, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99381, encryptionId=2cc599381bd, topicName=非小细胞)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=2e07307, createdName=lingaifan, createdTime=Tue Jun 23 21:49:00 CST 2020, time=2020-06-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1661490, encodeId=f5081661490c7, content=<a href='/topic/show?id=34a110150800' target=_blank style='color:#2F92EE;'>#驱动基因#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=109, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=101508, encryptionId=34a110150800, topicName=驱动基因)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b94625296381, createdName=751943081_32627957, createdTime=Wed Jul 22 07:49:00 CST 2020, time=2020-07-22, status=1, ipAttribution=)]
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