Preface
Recently, the "Clinical Diagnosis and Treatment Pathway for Lung Cancer at the County Level in China (2023 Edition)" (hereinafter referred to as the "Pathway") compiled by the China Thoracic Oncology Research Collaboration Group was released [1]. The release of the "Path" not only responds to the "Healthy China 2030" strategy, but also provides strong support for the national "Thousand Counties Project", marking a solid step in promoting the construction of a hierarchical diagnosis and treatment system and improving the capacity of county-level medical services. The diagnosis and treatment path fully considers the actual situation of county-level medical institutions, and divides the diagnosis and treatment recommendations in clinical scenarios into "basic strategies" and "optional strategies", which not only ensures the scientificity and standardization of diagnosis and treatment, but also takes into account the flexibility and feasibility of practical operation. In order to further promote the implementation of the "Path", standardize the diagnosis and treatment behavior of county-level hospitals, and improve the quality of medical services, Yimaitong specially invited Professor Zhao Dong from Lixin County People's Hospital of Anhui Province, Professor Peng Zhengping from Liuyang People's Hospital of Hunan Province, Professor Zhang Lidong from Puning People's Hospital of Guangdong Province, and Professor Du Chi from Dujiangyan People's Hospital of Sichuan Province to interpret the treatment strategy of stage IV driver gene-negative non-small cell lung cancer (NSCLC).
Table 1. The significance of the basic strategies and optional strategies recommended for the clinical diagnosis and treatment pathway of lung cancer at the county level
Treatment of stage IV driver negative, non-squamous cell carcinoma NSCLC
First-line treatment for stage IV driver negative, non-squamous cell carcinoma NSCLC
In the past, patients with advanced non-squamous NSCLC who were negative for driver genes were treated with chemotherapy as the classic treatment regimen. However, in recent years, immunotherapy and anti-angiogenic drugs represented by programmed death receptor 1 (PD-1)/programmed death ligand 1 (PD-L1) inhibitors have brought epoch-making changes, further enriching the treatment options for such patients.
For patients with advanced non-squamous NSCLC with a PS score of 0~1 in driver gene, the first-line classic regimen is platinum-doublet chemotherapy, and the combination therapy based on platinum-doublet chemotherapy is currently being actively explored in clinical practice, and the prognosis of NSCLC can be significantly improved. The BEYOND study explored the combination of bevacizumab with standard chemotherapy in patients with metastatic or advanced non-squamous NSCLC, and the results confirmed that median progression-free survival (PFS) could be extended to 9.2 months (vs. 6.5 months; HR=0.40), and median overall survival (OS) was extended to 24.3 months (vs. 17.7 months; HR=0.88）[2]。 Based on the above evidence, the pathway recommends platinum-doublet chemotherapy and bevacizumab plus chemotherapy as basic strategies.
A number of large phase III studies have confirmed the effectiveness of PD-1/PD-L1 inhibitor combination chemotherapy in the first-line treatment of advanced non-squamous carcinoma NSCLC, and has now become the first-line standard treatment for stage IV driver negative non-squamous cancer NSCLC. The CAMEL study explored the efficacy and safety of camrelizumab plus chemotherapy compared with chemotherapy alone in the first-line treatment of advanced non-squamous carcinoma NSCLC, and the results confirmed that it significantly prolonged PFS (HR=0.60) and OS (median OS: 27.1 months vs. 19.8 months; HR=0.72）[3]； The ORIENT-11 study also showed that sintilimab plus chemotherapy significantly improved PFS (HR=0.49) and OS compared with chemotherapy alone in the first-line treatment of unresectable locally advanced or metastatic nonsquamous carcinoma NSCLC (median OS: 24.2 months vs. 24.2 months). 16.8 months; HR=0.65）[4]； RATIONALE304 study explored the effectiveness of tislelizumab in combination with platinum + pemetrexed compared with standard chemotherapy alone in patients with advanced nonsquamous cell carcinoma NSCLC, and the results also showed a significant prolongation of PFS (HR=0.63) [5]. The above three immune drugs and their treatment regimens have been included in the medical insurance, and the "Pathway" is recommended as a basic strategy (Table 2). In addition, pembrolizumab plus pemetrexed + platinum, atezolizumab plus platinum + pemetrexed, sugemalimab plus platinum + pemetrexed, and toripalimab plus platinum + pemetrexed have all been shown to significantly prolong the survival time of patients with advanced non-squamous cell carcinoma NSCLC compared with chemotherapy alone in phase III studies [6-9].
Figure 1. CAMEL study: OS analysis of camrelizumab plus chemotherapy versus chemotherapy alone in the first-line treatment of non-squamous NSCLC
Figure 2. ORIENT-11 study: OS analysis of sintilimab plus chemotherapy versus chemotherapy alone in the first-line treatment of non-squamous NSCLC
At the same time, for patients with positive PD-L1 expression, immunotherapy monotherapy has also demonstrated long-term benefit in first-line therapy. In the IMpower110 study of atezolizumab compared with chemotherapy in patients with stage IV nonsquamous or squamous NSCLC with PD-L1 expression (PD-L1 tumor cell [TC]≥50% or immune cell [IC] positive score ≥10%), atezolizumab improved OS compared with chemotherapy (median OS: 20.2 months vs. 14.7 months; HR=0.76）[10]。 In the KEYNOTE-024 study, which investigated pembrolizumab compared with chemotherapy in patients with a PD-L1 tumor cell positive ratio score (TPS) ≥of 50% (TPS), pembrolizumab significantly prolonged OS (median OS: 26.3 months vs. 13.4 months; HR = 0.62), and the five-year OS rate was 31.9 percent [11]. In the KEYNOTE-042 study, which investigated pembrolizumab compared with chemotherapy in a population ≥1% with PD-L1 TPS, pembrolizumab also significantly prolonged OS (median OS: 16.4 months vs. 12.1 months; HR = 0.79), and the five-year OS rate was 16.6 percent [12]. Since the medical insurance is not yet covered, the above plan is recommended as an optional strategy (Level I) in the "Pathway". (Table 2).
Figure 3. KEYNOTE-024: OS analysis of pembrolizumab vs. chemotherapy in 50% of patients with PD-L1 TPS ≥ first-line treatment
In addition to the above regimens, other immunization combination regimens have also shown good efficacy in driver-negative advanced NSCLC, but given that there are no approved indications in China, the pathway combines atezolizumab with bevacizumab and carboplatin + paclitaxel, atezolizumab with carboplatin and nab-paclitaxel, nivolumab in combination with ipilimumab (PD-L1 TPS ≥1%), nivolumab in combination with ipilimumab and two-cycle pemetrexed+Platinum-based chemotherapy is recommended as an optional strategy (level II) (Table 2).
For patients with PS score = 2, first-line single-agent chemotherapy may prolong survival and improve quality of life compared with best supportive care, and the options for single-agent chemotherapy include gemcitabine, vinorelbine, paclitaxel, docetaxel, and pemetrexed (basic strategy recommendation).
Second- and late-line treatment for stage IV driver-negative, non-squamous cell carcinoma NSCLC
For patients with disease progression after first-line standard chemotherapy, PD-1/PD-L1 inhibitor monotherapy has become the new second-line standard of care for NSCLC (including squamous and non-squamous cell carcinomas). In the RATIONALE 303 study, which investigated the efficacy of tislelizumab versus docetaxel in second- and third-line patients with locally advanced or metastatic NSCLC, tislelizumab demonstrated a significant prolongation of OS (median OS: 16.9 months vs. 16.9 months). 11.9 months; HR=0.66）[13]。 In view of the fact that tislelizumab monotherapy for the second-line treatment of non-squamous carcinoma NSCLC has been approved and included in the medical insurance, the "pathway" is recommended as a basic strategy. In the CheckMate-078 study of nivolumab versus docetaxel for second- and second-line therapy, nivolumab significantly prolonged OS and improved objective response rates (ORRs) in patients with stage IIIB/IV EGFR/ALK-negative NSCLC who had disease progression after platinum-doublet chemotherapy [14]. Since the second-line indication of nivolumab has not yet been included in the medical insurance, the pathway is recommended as an optional strategy (level I). In addition, pembrolizumab, atezolizumab and ramucirumab + docetaxel have not yet been approved for indications in China, so the Pathway is recommended as an optional strategy (Level II). In addition, if docetaxel or pemetrexed have not been used in the past, monotherapy with these two agents can also be used after first-line progression, and the pathway is recommended as a basic strategy.
Figure 4. RATIONALE303 study: OS analysis of tislelizumab versus docetaxel second- and third-line NSCLC
For patients who have progressed or relapsed after second-line therapy, the Pathway recommends anlotinib (at least 2 systemic chemotherapy treatments) and docetaxel/pemetrexed (previously unused) as basic strategies; Nivolumab (previously unused) and optimal supportive care are recommended as optional strategies for class I and class II, respectively (Table 2). Patients with a PS score of ≥3 are recommended for optimal supportive care (basic strategy recommendation).
Table 2. Treatment of patients treated with stage IV driver gene-negative non-squamous cell carcinoma NSCLC in the county-level lung cancer clinical diagnosis and treatment pathway
Treatment of stage IV driver negative, squamous cell carcinoma NSCLC
First-line treatment for stage IV driver negative, squamous cell carcinoma NSCLC
For a long time, the classic first-line treatment for stage IV driver-negative lung squamous cell carcinoma has been platinum-doublet chemotherapy. For patients with a PS score of 0~1, cisplatin/carboplatin combined with gemcitabine or docetaxel or paclitaxel/paclitaxel liposome are first-line options. In addition, compared with cisplatin plus docetaxel, the PFS and ORR were significantly higher than cisplatin plus docetaxel in advanced nonsquamous carcinoma [15], which can also be used as a first-line treatment. Based on the above evidence, the Pathway recommends the relevant platinum-containing chemotherapy regimen as a basic strategy.
With the continuous exploration of new treatment options and the continuous enrichment of evidence-based medical evidence of PD-1/PD-L1 inhibitor combined with chemotherapy, immunotherapy combined with platinum-doublet chemotherapy has become the first-line standard treatment for stage IV lung squamous cell carcinoma. The efficacy of tislelizumab in combination with paclitaxel + carboplatin or nab-paclitaxel + carboplatin in the first-line treatment of patients with advanced squamous NSCLC explored in RATIONALE307 studies showed that compared with chemotherapy alone, tislelizumab plus paclitaxel + carboplatin (median PFS: 7.6 months vs. 5.5 months; HR=0.524) versus combined nab-paclitaxel + carboplatin (median PFS: 7.6 months vs. 5.5 months; HR = 0.478) in the primary endpoint of PFS [16]. In the CameL-sq study of camrelizumab plus paclitaxel and carboplatin compared with chemotherapy alone in the first-line treatment of driver-negative advanced squamous NSCLC, there was a significant OS benefit (median OS: 27.4 months vs. 15.5 months; HR = 0.57), camrelizumab plus chemotherapy resulted in a three-year OS rate of 42.8 percent [17]. The ORIENT-12 study of sintilimab plus gemcitabine and platinum-based versus chemotherapy in the first-line treatment of advanced squamous NSCLC reaffirmed the effectiveness of immunotherapy in combination with chemotherapy, which significantly prolonged PFS (median PFS: 5.5 months vs. 4.9 months; HR=0.536）[18]。 Based on the above evidence, the Pathway recommends the relevant joint scheme as a basic strategy (Table 3).
In addition, among other immunization combinations, studies of pembrolizumab plus chemotherapy, sugemalimab plus chemotherapy, penpulimab plus chemotherapy, and serplulimab plus chemotherapy have all achieved positive results in patients with advanced squamous cell carcinoma NSCLC [8,19-21], but they are not yet covered by health insurance and are temporarily recommended as an optional strategy (Table 3). Similar to non-squamous NSCLC, for patients with squamous cell carcinoma NSCLC with positive PD-L1 expression, the pathway recommends pembrolizumab monotherapy (limited to PD-L1 TPS≥50% or TPS 1%~49%) and atezolizumab monotherapy (limited to PD-L1 TC≥50% or IC≥10%) as an optional (grade I) strategy.
Figure 5. CameL-sq study: OS analysis of camrelizumab plus chemotherapy vs. chemotherapy alone in the first-line treatment of squamous cell carcinoma NSCLC
For patients with stage IV lung squamous cell carcinoma with a PS score = 2 points, first-line single-agent chemotherapy may prolong survival and improve quality of life compared with best supportive care. Single-agent chemotherapy options include gemcitabine, vinorelbine, paclitaxel, and docetaxel (basic strategy recommendation). For patients who are not candidates for chemotherapy, optimal supportive care is recommended as an optional strategy (level II) (Table 3).
Second- and late-line treatment for stage IV driver negative, squamous cell carcinoma NSCLC
After first-line progression of squamous cell carcinoma NSCLC patients with negative driver genes and PS score of 0~2, if they have not received immunotherapy, immune monotherapy is recommended for second-line treatment (tislelizumab is recommended as a basic strategy, nivolumab is recommended as an optional strategy). In patients with non-selective squamous cell carcinoma who had received prior first-line chemotherapy, the LUX-Lung8 study of afatinib versus erlotinib in patients with advanced lung squamous cell carcinoma who had failed a platinum-containing regimen showed a significant improvement in OS compared with erlotinib (median OS: 7.8 months vs. 6.8 months; HR=0.84)[22], afatinib has been approved for the second-line treatment of advanced lung squamous cell carcinoma. For patients who have progressed on first-line or maintenance therapy, single-agent chemotherapy with docetaxel or gemcitabine is recommended for the second line. Vinorelbine may also be an option for chemotherapy in cases where docetaxel or gemcitabine chemotherapy is not a candidate. Based on the above evidence, and the relevant drugs have been included in the medical insurance, the Pathway recommends them as basic strategies (Table 3).
Figure 6. LUX-Lung8 study: OS analysis of afatinib versus erlotinib in second-line treatment of squamous cell carcinoma NSCLC
For patients who have progressed or relapsed after second-line therapy, the Pathway recommends anlotinib (peripheral squamous cell carcinoma only) and docetaxel (previously unused) as basic strategies; Nivolumab (previously unused) and optimal supportive care are recommended as optional strategies for class I and class II, respectively (Table 2).
Table 3. Treatment of patients with stage IV driver gene-negative squamous cell carcinoma NSCLC in the county-level lung cancer clinical diagnosis and treatment pathway
Message from the editorial board of "Path".
Professor Zhao Dong, Lixin County People's Hospital, Bozhou City, Anhui Province:
Lung cancer ranks first in mainland China, and doctors specializing in oncology have a long way to go. The IPASS study has pioneered the path of hope for patients with positive driver genes for lung cancer, but the majority of patients with negative driver genes are clinically speaking, and the treatment methods for these patients have been difficult to explore for a long time, and there have been rapid advances in recent years. The Clinical Diagnosis and Treatment Pathway for Lung Cancer at the County Level in China (2023 Edition) is formulated based on the existing domestic and foreign guidelines/consensus, combined with the actual situation of diagnosis and treatment at the county level in mainland China, and provides a scientific basis for the diagnosis and treatment of lung cancer for county oncologists. County doctors and relevant professionals should be guided by the guidelines and individualized treatment for patients in combination with humanistic care, balanced diet, exercise rehabilitation, emotional management, and symptom management.
Professor Peng Zhengping of Liuyang People's Hospital, Hunan Province:
With the strong support of top experts such as Professor Wu Yilong and Professor Zhou Qing in China, and with the active participation of oncology-related experts in many county hospitals in China, the "Pathway" fully refers to and follows a variety of latest guidelines and research results at home and abroad, fully considers the diagnosis and treatment capabilities of county hospitals and national medical insurance policies, which not only grasps the academic pulse, but also closely combines with national conditions, and is very operable, and is a red treasure book for lung cancer diagnosis and treatment in county hospitals. It is hoped that the doctors engaged in the clinical diagnosis and treatment of lung cancer in the county hospitals can study carefully and be proficient in it, so as to better benefit the cancer patients at the grassroots level. Although these patients have lost the opportunity to undergo surgery, if they can make comprehensive treatment decisions such as chemotherapy, immunization, anti-angiogenic and radiotherapy, and manage the whole process, many patients can still achieve good results and obtain a longer survival time and a better quality of life if they can be comprehensively evaluated through multidisciplinary collaboration (MDT) (including immunotherapy-related testing), and rationally carry out comprehensive treatment decisions such as chemotherapy, immunology, anti-angiogenic and radiotherapy. If we can fully grasp and carefully follow the path, we can better help the doctors engaged in cancer prevention and treatment in the county to complete their work and benefit cancer patients at the grassroots level.
Professor Zhang Lidong of Puning People's Hospital, Guangdong Province:
Patients with advanced NSCLC have a poor prognosis. Although targeted therapy for lung cancer significantly improved the survival benefit of patients with driver-positive advanced NSCLC, the effect was relatively limited in driver-negative patients. In recent years, immune checkpoint inhibitors have made significant progress in the treatment of driver negative NSCLC, and related clinical studies such as immune monotherapy and immunotherapy combined with chemotherapy have changed the treatment mode of these patients and brought significant survival benefits to patients. With the inclusion of immunotherapy drugs in medical insurance, tumor PD-L1 testing is necessary for patients with advanced NSCLC who are negative for driver genes. In the future, we look forward to the emergence of more new chemotherapy drugs, the development and marketing of new immune target drugs, and further inclusion in medical insurance, so as to provide more promising treatment options for patients with driver gene-negative NSCLC in counties.
Professor Du Chi of Dujiangyan People's Hospital of Sichuan Province:
Patients with advanced lung cancer who are positive for driver genes have benefited from targeted therapy, making long-term survival possible for patients with advanced lung cancer, which is inseparable from the research and development of drugs, the continuous progress of clinical research, and the promotion and popularization of guidelines. For the other part of patients with advanced lung cancer who are negative for driver genes, the basic treatment strategy is still chemotherapy or chemotherapy plus bevacizumab. With the clinical application of immune checkpoint inhibitors and the increase in drug accessibility, the combination of immunotherapy and chemotherapy and the use in second-line therapy are gradually changing the layout and efficacy of treatment for these patients. The Clinical Diagnosis and Treatment Pathway for Lung Cancer at the County Level in China (2023 Edition) provides scientific and practical guidance for the treatment of advanced lung cancer patients with negative driver genes in the county, which is helpful to improve the understanding level of county oncologists, better meet the clinical needs of local treatment for these patients, and achieve the goal of "no serious illness in the county".
Expert Profile
Prof. Dong Zhao
- Vice President and Chief Physician of Lixin County People's Hospital
- Vice Chairman of the First Committee of the Radiation Oncology Branch of Bozhou Medical Association
- He is a member of the Standing Committee of the First Committee of the Oncology Branch of Bozhou Medical Association
- He is a member of the Standing Committee of the First Committee of the Medical Oncology Branch of Bozhou Medical Association
- Member of the Tumor Immunology Professional Committee of Anhui Society of Clinical Oncology
- He is a member of the Radiation Oncology Professional Committee of the Anhui Clinical Oncology Society of the Chinese Medical Association
- He was a member of the first session of the Lung Cancer Professional Committee of the Anhui Geriatrics Society
- He is a standing member of the Cancer Prevention and Science Popularization Professional Committee of Anhui Anti-Cancer Association
- Member of the Gynecologic Oncology Professional Committee of Anhui Society of Clinical Oncology
- Member of the Brachytherapy Professional Committee of Anhui Branch
- Member of the Lung Cancer Expert Committee of the National Center for Telemedicine and Internet Medicine
- Member of the 3rd Precision Radiotherapy Professional Committee of Anhui Anti-Cancer Association
Expert Profile
Prof. Zhengping Peng
- Director of the Department of Oncology and Hematology of Liuyang People's Hospital and Chief Physician
- Executive Vice Chairman of the Cancer Prevention and Treatment Professional Committee of Hunan Health Management Society
- Youth member of Hunan Provincial Chemotherapy (Internal Medicine) Professional Committee
- Member of the Hematology Branch of Hunan Medical Doctor Association
- Member of the Nutrition and Supportive Care Committee of the Provincial Anti-Cancer Association
- Member of the Brain Metastasis Professional Committee of the Provincial Anti-Cancer Association
- Executive Director of the Blood Health Branch of the Provincial Health Service Association
- Member of the Clinical Oncology and MDT Committee of the Provincial Association for the Promotion of International Medical Exchange
- Member of the Standing Committee of the Provincial International Medical Promotion Association Precision Radiotherapy and Artificial Intelligence Special Committee
- Member of Changsha Internal Medicine Association
- Member of Changsha Cancer Chemotherapy Quality Control Center
- Head of the hematology and oncology group of Liuyang Oncology Specialty Alliance
Expert Profile
Prof. Lidong Zhang
- Director of the Oncology Department of Puning People's Hospital and Chief Physician
- Member of the Oncology Branch of Guangdong Medical Association
- Member of Medical Oncology Branch of Guangdong Medical Association
- Member of the Standing Committee of the Gastrointestinal Oncology Branch of the Guangdong Precision Medicine Application Society
- Member of the Lung Cancer Treatment and Clinical Research Committee of Guangdong Clinical Medical Association
- Member of the Multi-Primary and Unknown Primary Professional Committee of Guangdong Anti-Cancer Association
- Member of the Cancer Screening and Early Diagnosis and Treatment Professional Committee of Guangdong Anti-Cancer Association
Expert Profile
Prof. Du Chi
- Director of the Department of Oncology, Dujiangyan People's Hospital, Doctor of Oncology, Deputy Chief Physician
- Sichuan Provincial Health and Family Planning Commission 12th batch of oncology academic and technical leaders reserve candidates
- Member of the Tumor Imaging and Rehabilitation Therapy Group of the Cancer Rehabilitation Branch of the Chinese Society of Gerontology and Geriatrics
- Member & Secretary of the Standing Committee of the Head and Neck Tumor Committee of the Western Radiotherapy Association
- Member of the Standing Committee of the Tumor Rehabilitation Committee of the Sichuan Geriatrics Society
- Member of the Standing Committee of the Primary Cancer Prevention and Treatment Committee of the Sichuan Provincial Preventive Medicine Association
- Member of the Radiation Oncology Committee of Sichuan Medical Association
- Member of the Oncology Committee of Sichuan Medical Association
- Chairman of the 3rd Special Committee of Radiation Oncology of Neijiang Medical Association
bibliography
1. Yilong Wu, Qing Zhou, China Thoracic Tumor Research Collaborative Group. Clinical diagnosis and treatment pathway of lung cancer at the county level in China (2023 edition)[J]. Chinese Journal of Oncology, 2024, 46(1):19-39.
2.Zhou CC, Wu YL, Chen GY, et al. BEYOND: A randomized, double-blind, placebo-controlled, multicenter, phase Ⅲstudy of first-line carboplatin/paclitaxel plus bevacizumab or placebo in chinese patients with advanced or recurrent nonsquamous non-small-cell lung cancer[J]. J Clin Oncol, 2015, 33(19):2197-2204.
3.Zhou C, Chen G, Huang Y, et al. Camrelizumab Plus Carboplatin and Pemetrexed as First-Line Treatment for Advanced Nonsquamous NSCLC: Extended Follow-Up of CameL Phase 3 Trial[J]. J Thorac Oncol. 2023 May; 18(5):628-639.
4.Zhang L, Wang Z, Fang J, et al. Final overall survival data of sintilimab plus pemetrexed and platinum as First-Line treatment for locally advanced or metastatic nonsquamous NSCLC in the Phase 3 ORIENT-11 study[J]. Lung Cancer. 2022 Sep;171:56-60.
5.Lu S, Wang J, Yu Y, et al. Tislelizumab plus chemotherapy as first-line treatment for locally advanced or metastatic nonsquamous NSCLC (RATIONALE 304): a randomized phase 3 trial[J]. J Thorac Oncol, 2021, 16(9): 1512-1522.
6.Garassino MC, Gadgeel S, Speranza G, et al. Pembrolizumab Plus Pemetrexed and Platinum in Nonsquamous Non-Small-Cell Lung Cancer: 5-Year Outcomes From the Phase 3 KEYNOTE-189 Study[J]. J Clin Oncol. 2023 Apr 10; 41(11):1992-1998.
7.Nishio M, Barlesi F, West H, et al. Atezolizumab plus chemotherapy for first-line treatment of nonsquamous NSCLC: results from the randomized phase 3 IMpower132 trial[J]. J Thorac Oncol, 2021, 16(4):653-664.
8.Zhou CC, Wang ZP, Sun YP, et al. Sugemalimab versus placebo, in combination with platinum-based chemotherapy, as first-line treatment of metastatic non-small-cell lung cancer (GEMSTONE-302): interim and final analyses of a double-blind, randomised, phase 3 clinical trial[J]. Lancet Oncol, 2022, 23(2): 220-233.
9.Jie Wang, Zhijie Wang, Lin Wu, et al. Final overall survival and biomarker analyses of CHOICE-01: A double-blind randomized phase 3 study of toripalimab versus placebo in combination chemotherapy for advanced NSCLC without EGFR/ALK mutations. 2023 ASCO Annual Meeting. Abstract #9003.
10.Jassem J, de Marinis F, Giaccone G, et al. Updated Overall Survival Analysis From IMpower110: Atezolizumab Versus Platinum-Based Chemotherapy in Treatment-Naive Programmed Death-Ligand 1-Selected NSCLC[J]. J Thorac Oncol. 2021 Nov; 16(11):1872-1882.
11.Reck M, Rodríguez-Abreu D, Robinson AG, et al. Five-Year Outcomes With Pembrolizumab Versus Chemotherapy for Metastatic Non-Small-Cell Lung Cancer With PD-L1 Tumor Proportion Score ≥ 50[J]. J Clin Oncol. 2021 Jul 20; 39(21):2339-2349.
12.de Castro G Jr, Kudaba I, Wu YL, et al. Five-Year Outcomes With Pembrolizumab Versus Chemotherapy as First-Line Therapy in Patients With Non-Small-Cell Lung Cancer and Programmed Death Ligand-1 Tumor Proportion Score ≥ 1% in the KEYNOTE-042 Study[J]. J Clin Oncol. 2023 Apr 10; 41(11):1986-1991.
13.Zhou CC, Huang DZ, Fan Y, et al. Tislelizumab versus docetaxel in patients with previously treated advanced NSCLC (RATIONALE-303): a phase 3, open-label, randomized controlled trial[J]. J Thorac Oncol, 2023, 18(1):93-105.
14.Wu YL, Lu S, Cheng Y, et al. Nivolumab versus docetaxel in a predominantly chinese patient population with previously treated advanced NSCLC: CheckMate 078 randomized phase Ⅲ clinical trial[J]. J Thorac Oncol, 2019, 14(5):867-875.
15.Lu S, Chen ZW, Hu CP, et al. Nedaplatin plus docetaxel versus cisplatin plus docetaxel as first-line chemotherapy for advanced squamous cell carcinoma of the lung - a multicenter, open-label, randomized, phase Ⅲ trial[J]. J Thorac Oncol, 2018, 13(11): 1743-1749.
16.Wang J, Lu S, Yu XM, et al. Tislelizumab plus chemotherapy vs chemotherapy alone as first-line treatment for advanced squamous non-small-cell lung cancer: a phase 3 randomized clinical trial[J]. JAMA Oncol, 2021, 7(5):709-717.
17.Zhou CC, et al. First-line camrelizumab plus carboplatin and paclitaxel for advanced squamousnon-small-cell lung cancer: Updated overall survival results from the phase 3 CameL-sq trial. 2022 ELCC. Abstract #3MO.
18.Zhou CC, Wu L, Fan Y, et al. Sintilimab plus platinum and gemcitabine as first-line treatment for advanced or metastatic squamous NSCLC: results from a randomized, double-blind, phase 3 trial (ORIENT-12)[J]. J Thorac Oncol, 2021, 16(9):1501-1511.
19.Novello S, Kowalski DM, Luft A, et al. Pembrolizumab Plus Chemotherapy in Squamous Non-Small-Cell Lung Cancer: 5-Year Update of the Phase III KEYNOTE-407 Study[J]. J Clin Oncol. 2023 Apr 10; 41(11):1999-2006.
20.Zhong H, Sun S, Chen J, et al. First-line penpulimab combined with paclitaxel and carboplatin for metastatic squamous non-small-cell lung cancer in China (AK105-302): a multicentre, randomised, double-blind, placebo-controlled phase 3 clinical trial[J]. Lancet Respir Med. 2024 Jan 31:S2213-2600(23)00431-9.
21.Zhou C, Hu Y, Arkania E, et al. A global phase 3 study of serplulimab plus chemotherapy as first-line treatment for advanced squamous non-small-cell lung cancer (ASTRUM-004) [J]. Cancer Cell. 2024 Feb 12; 42(2):198-208.e3.
22.Goss GD, Cobo M, Lu S, et al. Afatinib versus erlotinib as second-line treatment of patients with advanced squamous cell carcinoma of the lung: final analysis of the randomized phase 3 LUX-Lung 8 trial[J]. EclinicalMedicine, 2021, 37:100940.
This material is provided by AstraZeneca and is intended for healthcare professionals only
审批编号：CN-135174
Expiration date: 2024-8-12
Edited by Shirky
审校:Gold
Typesetting: KIKI
Executive: Babel
This platform aims to deliver more medical information to healthcare professionals. The content published on this platform should not be used as a substitute for professional medical guidance in any way, nor should it be regarded as diagnosis and treatment advice. If such information is used for purposes other than understanding medical information, the platform does not assume relevant responsibilities. This platform does not mean that it agrees with its descriptions and views on the published content. If copyright issues are involved, please contact us, and we will deal with it as soon as possible.