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REVIEW ARTICLE: GUIDELINES
Year : 2021  |  Volume : 4  |  Issue : 2  |  Page : 279-314

Treatment of advanced non-small-cell lung cancer: First line, maintenance, and second line– Indian consensus statement update(Under the aegis of Lung Cancer Consortium Asia, Indian Cooperative Oncology Network, Indian Society of Medical and Pediatric Oncology, Molecular Oncology Society, and Association of Physicians of India)


1 Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, New Delhi, India
2 Department of Medical Oncology, HOPE Oncology Care Clinic, New Delhi, India
3 Department of Medical Oncology, Clinical and Translational Oncology Research, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Ernakulam, India
4 Department of Medical Oncology, Silverline Hospital, Ernakulam, India
5 Department of Medical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Delhi, India
6 Department of Medical Oncology, Bangalore Institute of Oncology, Kerala, India
7 Department of Medical Oncology, Bombay Hospital and Medical Research Centre, Kerala, India
8 Department of Medical Oncology, Bhaktivedanta Hospital and Research Institute Adult Solid Medical Oncology, Kerala, India
9 Department of Medical Oncology, MVR Cancer Institute, Calicut, India
10 Department of Medical Oncology, Yashoda Cancer Institute, Secunderabad, Telangana, India
11 Department of Medical Oncology, St. Johns Medical College and Hospital, HCG Hospitals, Bengaluru, Karnataka, India
12 Department of Medical Oncology, Prince Aly Khan Hospital, Oncology Clinic, Mumbai, Maharashtra, India
13 Department of Medical Oncology, Max Institute of Cancer Care, Saket, India
14 Department of Medical Oncology, Shatabdi Super Speciality Hospital, Nashik, Maharashtra, India

Correspondence Address:
Kumar Prabhash
Department of Medical Oncology, Tata Memorial Hospital, Dr. Ernest Borges Road, Homi Bhabha National Institute, Parel, Mumbai, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/crst.crst_61_21

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The management of patients with advanced non-small-cell lung cancer (NSCLC) is becoming increasingly complex, with the identification of driver mutations/rearrangements and the development and availability of appropriate targeted therapies. In 2018, a group of medical oncologists with expertise in treating lung cancers used data from the published literature and experience to arrive at practical consensus recommendations for the treatment of advanced NSCLC for use by the community oncologists. These recommendations were subsequently published in 2019, with a plan to be updated annually. This article is an update to the 2019 consensus statement. For updating the consensus statement, a total of 25 clinically relevant questions on the management of patients with NSCLC on which consensus would be sought were drafted. The PubMed database was searched using the following terms combined with the Boolean operator “AND:” (lung cancer, phase 3, non-small cell lung cancer AND non-small-cell lung cancer [MeSH Terms]) AND (clinical trial, phase 3 [MeSH Terms]) AND (clinical trial, phase iii [MeSH Terms]). In addition, “carcinoma, non-smallcell lung/drug therapy” (MeSH Terms), “lung neoplasms/drug therapy” (MeSH), clinical trial, phase III (MeSH Terms) were used to refine the search. The survey results and literature were reviewed by the core members to draft the consensus statements. The expert consensus was that molecular testing is a crucial step to be considered for patients with NSCLC at baseline, and in those who progress on first-line chemotherapy and have not undergone any prior testing. For mutations/rearrangement-negative patients who progress on first-line immunotherapy, doublet or single-agent chemotherapy with docetaxel and/or gemcitabine and/or ramucirumab should be considered. Patients who progress on the newer anaplastic lymphoma kinase inhibitors should be considered for second-line therapy with lorlatinib or systemic chemotherapy. Maintenance therapy with pemetrexed is preferred for NSCLC with non-squamous histology and should be avoided in NSCLC with squamous histology.


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