Individualización del tratamiento en Adenocarcinoma de pulmón tras la primera línea de quimioterapia

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Disease progression after platinum-based doublet
Decision-making factors
Non-squamous Carcinoma
Consider rebiopsy: EGFR, ALK, ROS1 status if unknown, PD-L1 expression
Wild-type EGFR and no ALK /ROS1 rearrangement
Co-morbidities, CI to immunotherapy,
Eligibility to anti-angiogenic agents
PS 0-1, No CI to immunotherapy
PD-L1 +? (cut-off?)
Docetaxel + nintedanib
Docetaxel + ramucirumab
Docetaxel or pemetrexed
If CI to anti-angiogenic agent
Nivolumab
or pembrolizumab
(Atezolizumab*)
Erlotinib
Nivolumab
if no CI to CP inhibitor
2
nd
line
3rd
line
Nivolumab
If no CI to immunotherapy
& PS 0 or 1
Squamous Carcinoma
Docetaxel ± ramucirumab
Erlotinib or afatinib
Docetaxel + nintedanib
Docetaxel + ramucirumab
Docetaxel or pemetrexed
if CI to anti-angiogenic agent
CI to immunotherapy
And/or rapid disease progression
And/or no PD-L1 expression
2016 Proposal for Treatment Algorithm Modified from Maurice Perol
Presented By Jean-Charles Soria at 2016 ASCO Annual Meeting