The Japanese Lung Cancer Society Guideline for non-small cell lung cancer, stage IV

Abstract

According to rapid development of chemotherapy in advanced non-small cell lung cancer (NSCLC), the Japan Lung Cancer Society has been updated its own guideline annually since 2010. In this latest version, all of the procedure was carried out in accordance with grading of recommendations assessment, development and evaluation (GRADE) system. It includes comprehensive literature search, systematic review, and determination of the recommendation by multidisciplinary expert panel which consisted of medical doctors, pharmacists, nurses, statisticians, and patients from patient advocacy group. Recently, we have had various types of chemotherapeutic drugs like kinase inhibitors or immune-checkpoint inhibitors. Thus, the guideline proposes to categorize patients into three entities: (1) driver oncogene-positive, (2) PD-L1 ≥ 50%, and (3) others. Based on this subgroup, 31 clinical questions were described. We believe that this attempt enables clinicians to choose appropriate treatment easier. Here, we report an English version of the Japan Lung Cancer Society Guidelines 2018 for NSCLC, stages IV.

Keywords: Chemotherapy; Guideline; Kinase inhibitor; Non-small cell lung cancer; Programed cell death-1 inhibitor; Programed death-ligand 1 inhibitor.

Fig. 1

After diagnosis, patients will be categorized into three subgroups. EGFR epidermal growth factor receptor, ALK anaplastic lymphoma kinase, PD-L1 programed death-ligand 1

Fig. 2

Treatment strategy of each subgroups in NSCLC, stage IV. PD-1 programed cell death-1, PD-L1 programed death-ligand 1

Fig. 3

Treatment strategy in driver oncogene-positive NSCLC, stage IV. EGFR epidermal growth factor receptor, ALK anaplastic lymphoma kinase, PD-1 programed cell death-1, PD-L1 programed death-ligand 1, NSCLC non-small cell lung cancer

Fig. 4

First-line treatment of EGFR-mutated NSCLC, stage IV. EGFR epidermal growth factor receptor, TKI tyrosine-kinase inhibitor, PS performance status

Fig. 5

Second-line or further treatment of EGFR-mutated NSCLC, stage IV. EGFR epidermal growth factor receptor, ALK anaplastic lymphoma kinase, TKI tyrosine-kinase inhibitor, PS performance status, NSCLC non-small cell lung cancer

Fig. 6

First-line treatment of ALK-rearranged NSCLC, stage IV. Abbreviations: ALK; anaplastic lymphoma kinase, TKI; tyrosine-kinase inhibitor, PS; performance status

Fig. 7

Second-line or further treatment of ALK-rearranged NSCLC, stage IV. PS performance status, NSCLC non-small cell lung cancer

Fig. 8

Treatment of ROS1-rearranged NSCLC, stage IV. PS performance status, NSCLC non-small cell lung cancer

Fig. 9

Treatment of BRAF-mutated NSCLC, stage IV. PS performance status, NSCLC non-small cell lung cancer

Fig. 10

Treatment strategy in PD-L1 ≥ 50% NSCLC, stage IV. PD-1 programed cell death-1, PD-L1 programed death-ligand 1, PS performance status

Fig. 11

First-line treatment in patients with stage IV NSCLC, who were driver oncogene-negative and PD-L1 was < 50%, or unknown. PD-1 programed cell death-1, PD-L1 programed death-ligand 1, PS performance status

Fig. 12

Second-line and further treatment in patients with stage IV NSCLC, who were driver oncogene-negative and PD-L1 was < 50%, or unknown. PD-1 programed cell death-1, PD-L1 programed death-ligand 1, PS performance status