Approach to stage IV non-small-cell lung cancer: how to select among first-line therapy options?

Curr Opin Pulm Med. 2020 Jul;26(4):311-320. doi: 10.1097/MCP.0000000000000659.


Purpose of review: There are several first-line systemic therapy options for patients with newly diagnosed stage IV non-small-cell lung cancer. Targeted therapy with tyrosine kinase inhibitors provide a good first option for some. Unfortunately, most patients do not have an alteration for which there is an available tyrosine kinase inhibitor. For these patients there are immunotherapy and chemoimmunotherapy options; however, there is debate about how to choose amongst these treatments for a given individual. This review attempts to simplify this decision-making process.

Recent findings: The data on first-line immunotherapy and chemoimmunotherapy regimens is highlighted. Programed death ligand-1 cut-points and how these may influence therapy decision making are discussed. Molecular markers that may help predict benefit or lack thereof in patients treated with immunotherapy regimens are touched upon.

Summary: Provided is a guide for the practicing clinician to help them select amongst immunotherapy and chemoimmunotherapy options for a given patient.

Publication types

  • Review

MeSH terms

  • Carcinoma, Non-Small-Cell Lung / diagnosis
  • Carcinoma, Non-Small-Cell Lung / therapy*
  • Combined Modality Therapy
  • Humans
  • Immunotherapy / methods*
  • Lung Neoplasms / diagnosis
  • Lung Neoplasms / therapy*
  • Neoplasm Staging*