부산대학교 도서관

First line therapy in advanced or metastatic non-small cell lung cancer (NSCLC) has undergone rapid changes in the past 15 years. Previously, doublet based chemotherapy was the standard of care, with the recent evolution of targeted therapy and now immunotherapy. Treatment selection depends on tumor pathologic subtype, the presence of targetable genomic aberrations (EGFR, ALK, ROS1, BRAF, NTRK), and PD-L1 tumour proportion score (TPS). If the patient’s tumor harbors an oncogenic driver including activating EGFR mutations, ALK, ROS-1 or TRK fusions, the optimal first-line treatment is targeted therapy. In the absence of oncogenic drivers, treatment selection is based on PD-L1 TPS. If PD-L1 TPS is ≥50%, pembrolizumab monotherapy is preferred, although combination chemotherapy-immunotherapy is an option. If PD-L1 TPS is <50%, combination chemotherapy-immunotherapy is recommended in good performance status patients, with different options for those with squamous and non-squamous pathology. Patient factors play a key role in treatment decision-making, first and foremost patient preference, but also performance status, comorbidities such as autoimmune disease, and steroid use.