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NSCLC Treatment Paradigm
Expert View on the Evolving Treatment Paradigm in Advanced NSCLC

Released: June 23, 2020

Expiration: June 22, 2021

Matthew Gubens
Matthew Gubens, MD, MS
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In this module, Matthew Gubens, MD, MS, provides an overview of the current status of advanced non-small-cell lung cancer (NSCLC) management, including recent advances in targeted agents, and immune checkpoint inhibitors.

The key points discussed in this module are illustrated with thumbnails from the accompanying downloadable PowerPoint slideset that can be found here or downloaded by clicking any of the slide thumbnails in the module alongside the expert commentary.

Clinical Care Options plans to measure the educational impact of this activity. Several questions will be asked twice: once at the beginning of the activity, and then once again after the discussion that informs the best choice. Your responses will be aggregated for analysis, and your specific responses will not be shared.

Before continuing with this educational activity, please take a moment to answer the following questions.

How many patients with advanced NSCLC do you typically provide care for in a month?

Case: RET Fusion–Positive NSCLC


A 47-year-old woman, who is a former smoker, presents with a cough. She is found to have metastatic lung adenocarcinoma that is negative for EGFR, ALK, ROS1, and BRAF mutations. She is also PD-L1 negative (ie, < 1% expression) and a next-generation sequencing (NGS) panel shows the KIF5B-RET fusion.

What is the most appropriate initial therapy?

Case: IO in Squamous NSCLC 


A 67-year-old man, who is a former smoker, developed increasing dyspnea with exertion (on stairs, up hills) and dry cough. He has a 46 pack-year smoking history, but quit 12 years ago. His medical history includes mild chronic obstructive pulmonary disease (COPD), hypertension, and controlled diabetes. After a failed steroid trial and antibiotics for presumed COPD flare and pneumonia, respectively, a chest x-ray revealed a dominant left upper lobe mass and likely other lung nodules. CT imaging of the chest/abdomen confirmed a 6.4-cm mass in the left upper lobe (LUL), 3 other lung nodules (bilateral) up to 2.2 cm, and a right adrenal nodule.



A biopsy of the right adrenal nodule showed squamous cell carcinoma. Laboratory testing showed PD-L1 10% (by 22C3 IHC) and the tumor mutational burden (TMB) was not assessed. PET/CT imaging showed all visible areas on CT were PET avid. The median standardized uptake value was 15 in the primary tumor, 12 in the other lung nodules, and 7-8 in the right adrenal nodule. He was asymptomatic at L2. A brain MRI showed no intracranial metastatic disease or other significant findings. His Eastern Cooperative Oncology Group (ECOG) performance status (PS) was 1.

In your current practice, which of the following treatment options would you recommend for this patient?

Case: Managing Immune-related AEs with Nivolumab plus Ipilimumab


A 67-year-old man was diagnosed with metastatic adenocarcinoma NSCLC involving his lung, pleura, and liver. His PD-L1 expression level is 25% and he has no actionable mutations. The patient is currently being treated with first-line nivolumab plus ipilimumab. A CT scan at Week 6 showed a PR, and another at Week 12 showed further response. However, at Week 14, the patient notes a week of steady increase in his bowel movements. Typically 1-2 per day, he now experiences up to 7 watery bowel movements a day with mild cramping and urgency, although there is no blood in his stool. He has not traveled recently and has no sick contacts. Laboratory testing shows he is negative for Clostridium difficile toxin and ova and parasites.

How would you choose to initially manage his diarrhea?
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