
Clinical Stage IA
Positive mediastinal nodes
Negative mediastinal nodes
Treat as stage IIIA / IIIB
Positive Margins?
Surveillance
RT
Operable
Inoperable
Definitive RT or SRS











Non-Small Cell Lung Cancer (NSCLC)
Updated: 2017-08-18
NO
YES
Re-resection (preferred)
Regimens are being updated, and are not yet complete.
COMMENTS from Pathway Team
Treatment Pathways Index
NSCLC COME HOME Regimens


Stage IB, IIA, IIB (Node Negative)
Inoperable
SRS
Operable
CH LNG 1: Cisplatin
CH LNG 2: Carboplatin + pemetrexed
CH LNG 3: Cisplatin + pemetrexed
CH LNG 5: Paclitaxel + carboplatin
T3N0, T3N1 chest wall /
mediastinal / hilar invasion
Surgical Margins
T < 4 cm
Surveillance
T >= 4 cm
Re-resection (preferred)
- OR -
RT alone
Sequential chemoradiation:
CH LNG 4: Paclitaxel + carboplatin
CH LNG 5: Paclitaxel + carboplatin (weekly)
CH LNG 6: Cisplatin + vinblastine
CH LNG 14: Paclitaxel + carboplatin
Followed by thoracic RT
Chemotherapy:
CH LNG 4: Paclitaxel + carboplatin
CH LNG 5: Paclitaxel + carboplatin (weekly)
CH LNG 6: Cisplatin + vinblastine
CH LNG 14: Paclitaxel + carboplatin













Non-Small Cell Lung Cancer (NSCLC)
Updated: 2017-08-18
Negative
Positive
Resection
Regimens are being updated, and are not yet complete.
COMMENTS from Pathway Team

Treatment Pathways Index
NSCLC COME HOME Regimens




Stage IIIA
Concurrent RT, + one of:
CH LNG 1: Cisplatin
CH LNG 2: Carboplatin + pemetrexed
CH LNG 3: Cisplatin + pemetrexed
CH LNG 5: Paclitaxel + carboplatin
Re-Stage
CH LNG 3: Pemetrexed + cisplatin
CH LNG 4/5: Paclitaxel + carboplatin
CH LNG 7/8: Cisplatin + vinorelbine
CH LNG 9: Cisplatin + gemcitabine
CH LNG 10: Cisplatin + docetaxel
CH LNG 11: Paclitaxel
CH LNG 12: Docetaxel + carboplatin
Progressive or persistent disease
Treat as Metastatic
Stable
Surveillance









Non-Small Cell Lung Cancer (NSCLC)
Updated: 2017-08-18
RT and/or Surgery
Regimens are being updated, and are not yet complete.
COMMENTS from Pathway Team








Treatment Pathways Index
NSCLC COME HOME Regimens
Operable
Inoperable

Stage IIIB
Staging
Progressive or persistent disease
Treat as Metastatic
Stable
Surveillance







Non-Small Cell Lung Cancer (NSCLC)
Updated: 2017-08-18
Regimens are being updated, and are not yet complete.
COMMENTS from Pathway Team

Treatment Pathways Index
NSCLC COME HOME Regimens
Concurrent RT, + one of:
CH LNG 1: Cisplatin
CH LNG 2: Carboplatin + pemetrexed
CH LNG 3: Cisplatin + pemetrexed
CH LNG 5: Paclitaxel + carboplatin

Metastatic Disease
First Line Therapy
Non-Squamous
EGFR/ALK Negative
EGFR Positive
CH LNG 20: Crizotinib
Progression or intolerance
2nd line Therapy
CLICK
Test for T790M
Progression
Progression
Progression
CH LNG 21: Ceritinib
CH LNG : Nivolumab
- OR -
CH LNG: Pembrolizumab
(PDL-1 > 50%)
CH LNG : Nivolumab
- OR -
If PDL-1 > 50%:
CH LNG: Pembrolizumab
CH LNG: Osimertinib
CH LNG 18: Erlotinib
CH LNG 19: Afatinib
ALK / ROS-1 Positive
CH LNG 2: Carboplatin +
pemetrexed
CH LNG 28: Paclitaxel +
carboplatin +/-
bevacizumab
Maintenance therapy:
CH LNG 16: Pemetrexed
CH LNG 17: Bevacizumab
OR
Observation

Progression
Non-Small Cell Lung Cancer (NSCLC)
Updated: 2017-08-18
Regimens are being updated, and are not yet complete.
COMMENTS from Pathway Team

Treatment Pathways Index
NSCLC COME HOME Regimens

Positive
Negative






















Metastatic Disease
First Line Therapy
Squamous
PS 0-2
Progression
PS 3-4
CH LNG 4/5: Carboplatin + paclitaxel
CH LNG 9: Cisplatin + gemcitabine +/- necitumumab
CH LNG 10: Cisplatin + docetaxel
CH LNG 12: Carboplatin + docetaxel
CH LNG 22: Carboplatin + gemcitabine
CH LNG 24: Docetaxel
CH LNG 30: Nivolumab
CH LNG 31: Pembrolizumab (PD-L1 positive only)
– OR –
Best Supportive Care
CH LNG 24: Docetaxel
CH LNG 26: Gemcitabine
CH LNG 27: Vinorelbine
CH LNG 30: Nivolumab
CH LNG 31: Pembrolizumab (PD-L1 positive only)
CH LNG 32: Atezolizumab
– OR –
Best Supportive Care







Non-Small Cell Lung Cancer (NSCLC)
Updated: 2017-08-18
Regimens are being updated, and are not yet complete.
COMMENTS from Pathway Team

Treatment Pathways Index
NSCLC COME HOME Regimens



Metastatic Disesse
Second Line Therapy
CH LNG 3: Cisplatin + Pemetrexed
CH LNG 24: Docetaxel
CH LNG 25: Pemetrexed (nonsquamous)
CH LNG 26: Gemcitabine
CH LNG 27: Vinorelbine
CH LNG 28: Paclitaxel + Carboplatin + Bevacizumab
CH LNG 30: Nivolumab
CH LNG 31: Pembrolizumab (PD-L1 positive only)
CH LNG 32: Atezolizumab
Progression
PS 0-2
PS 3-4
Non-Small Cell Lung Cancer (NSCLC)
Updated: 2017-08-18
Best Supportive Care
Regimens are being updated, and are not yet complete.
COMMENTS from Pathway Team

Treatment Pathways Index
NSCLC COME HOME Regimens







