What are the first-line treatment recommendations for non-small cell lung cancer (NSCLC) stage IV or recurrent disease?

Updated: Jul 15, 2021
  • Author: Marvaretta M Stevenson, MD; Chief Editor: Nagla Abdel Karim, MD, PhD  more...
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Patients with metastatic disease (stage IV) or recurrent disease after primary therapy (eg, surgery and/or radiation) should be considered for palliative treatment in order to improve quality of life, palliate symptoms, and improve overall survival. [13, 7]  These patients should undergo molecular testing for oncogenes and PD-L1.

Factors to be considered in the treatment choice for these patients include:

  • Presence of an oncogene (eg,  EGFR, ALK)
  • Tumor histology (squamous versus non-squamous)
  • Candidacy for immune checkpoint inhibitors (immunotherapy)
  • Performance status and co-morbidities 

Patients with advanced or recurrent disease with actionable oncogenes should be considered for treatment with targeted therapy (see section below). Patients without an actionable genetic alteration should be treated with chemotherapy alone, chemotherapy with immunotherapy, or immunotherapy alone. Patients with poor performance status or co-morbidities can be considered for single-agent chemotherapy, immunotherapy, or (if they have an actionable oncogene) targeted therapy. 


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