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

Stage IB, IIA, IIB (Node Negative)

Inoperable

SRS

Operable

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

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

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

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

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

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

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