Loading

Lung Cancer, non small lung cancer (NSCLC)

This is the short version of onkopedia guidelines for the German-speaking countries. It focuses on algorithms for treatment in different stages with links to the evidence and its appraisal.
ICD-10 C34
Date of document October 2019
This is the current valid version of the document

1Summary

Lung cancer is the third most frequent malignancy in women and the second most frequent malignancy in men. The median age at diagnosis is between 68 and 70 years. Major risk factor is smoking.

Screening of asymptomatic high-risk persons via low-dose computer tomography (LDCT) can identify lung cancer in early stages. It reduces cancer-specific and overall mortality, especially in women.

Treatment of patients with lung cancer is paradigmatic for modern oncology. NSCLC can now be subdivided in more than a dozen biological entities with individual treatment concepts. Prognosis of patients is determined by stage, histology, immunohistochemistry, sex, ECOG status and comorbidity.

Treatment options include surgery, radiation and systemic treatment, often combined in multimodal concepts. Treatment in early stages and in some patients with advanced stage is curative. For patients in stage IIIB/IV the integration of immune checkpoint and of kinase inhibitors has significantly improved their prognosis.

2[Kapitel nicht relevant]

3[Kapitel nicht relevant]

4[Kapitel nicht relevant]

5[Kapitel nicht relevant]

6Therapy

6.1Therapeutic algorithm

6.1.1Primary therapy

Primary therapy is based on the criteria of the 8th lung cancer TNM classification and clinical staging system, see Figure 1.

Figure 1: Algorithm for Primary Therapy 
Algorithm for Primary Therapy
curative therapy; palliative therapy;
1 clinical stages;
2 see figure

6.1.2Systemic therapy in advanced stages

Recommendations are based on predictive, histological, immunohistochemical and genetic markers, see Figure 2.

Figure 2: Systemic therapy in advanced stages - overview 
Systemic therapy in advanced stages - overview
6.1.2.1Molecular genetic stratification of therapy

This chapter contains recommendations for targeted first- and second-line treatment, see Figure 3.

Figure 3: Molecular genetic stratification in advanced stages  
Molecular genetic stratification in advanced stages
1no ALK1-, ROS11-, EGFR1- mutations/translocations, ALK – Anaplastic Lymphoma Kinase, ROS1 – tyrosine protein kinase ROS, EGFR – Epidermal Growth Factor Receptor, BRAFV600E – point mutation in the BRAF gene; 2other genetic aberrations – RET aberration, c-MET Exon 14 skipping mutation or MET amplification, NTRK fusions; 3UC – uncommon mutations, UC I – point mutations or duplicatios in EGFR exons 18-21, UCII – mutation T790M in EGFR exon 20 alone or in combination with other mutations, UC III – exon 20 insertions; 4 ALKi – ALK-inhibitor: alectinib, brigatinib, ceritinib, crizotinib, lorlatinib; 5 ROSi – ROS1-inhibitor: ceritinib, crizotinib, cabozantinib, lorlatinib; 6 EGFR-TKI – afatinib, dacomitinib, erlotinib, gefitinib, osimertinib; 7 dabrafenib/trametinib is approved for first and second line therapy by the EU; 8 CR – complete remission, PR – partial remission, SD – stable disease, PD – progressive disease; 9 other systemic therapy, e. g. carboplatin/paclitaxel/atezolizumab/bevacizumab; 10 see approval status;
6.1.2.2No molecular genetic stratification of therapy

The majority of patients with NSCLC does not have predictive markers for molecular stratified therapy. Immunochemotherapy has become the standard of care in the first line treatment of these patients, see Figure 4.

Figure 4: No molecular genetic stratification advanced stages  
No molecular genetic stratification advanced stages
1PD-L1 TPS – expression of PD-L1 on tumor cells, quantified by the Tumor Progression Score (TPS); 2 suitable for immunotherapy with no significant contraindications; 3 combination of an immune checkpoint inhibitor and histology-stratified chemotherapy; 4 combination of cis- or carboplatin and pemetrexed; 5 combination of carboplatin and paclitaxel or nab paclitaxel; 6 CR – complete remission, PR – partial remission, SD – stable disease, PD – progressive disease; 7 nintedanib only in adenocarcinoma; 8 third generation cytostatic drugs: gemcitabine, pemetrexed, vinorelbine; pemetrexed only in non-squamous cell carcinoma; 9 afatinib only in squamous cell carcinoma; 10 PD-1/PD-L1 inhibitor: atezolizumab (independent of PD-L1 expression), nivolumab (independent of PD-L1 expression), pembrolizumab (only with TPS ≥1%); efficacy has not been demonstrated in patients who received immune checkpoint inhibitors in first line;

6.2Facts and Appraisal

6.2.1Adjuvant therapy

6.2.1.1Adjuvant chemotherapy

Adjuvant chemotherapy is recommended in patients with stages II-IIIA after surgical R0 resection. Data are summarized in Figure 5 and Figure 6.

Figure 5: Adjuvant chemotherapy in NSCLC (ANITA trial) 
Adjuvant chemotherapy in NSCLC (ANITA trial)
1 N - number of patients; 3 DFS – disease-free survival rate after 76 months, in %; 4 OS – overall survival rate after 76 months, in %; 7 results for control, results for new therapy; 8 hazard ratio for new therapy;
Publication: DOI:10.1016/S1470-2045(06)70804-X
Figure 6: Adjuvant chemotherapy in NSCLC (IALT trial);  
Adjuvant chemotherapy in NSCLC (IALT trial);
1 N - number of patients; 2 RR - remission rate, in %; 3 DFS – disease-free survival; 4 OS – overall survival; 8 hazard ratio for new therapy;
Publication: DOI:10.1200/JCO.2009.23.2272
6.2.1.2Adjuvant immunotherapy
6.2.1.2.1Durvalumab, Stage III, after radiochemotherapy

Data are summarized in Figure 7.

Figure 7: Durvalumab in NSCLC, Stage III, after radiochemotherapy 
Durvalumab in NSCLC, Stage III, after radiochemotherapy
1 N - number of patients; 2 RR - remission rate, in %; 3 PFS - progression-free survival, in months; 4 OS – overall survival, in months; 5 QoL – quality of life; 6 SAE – serious adverse events, CTCAE grade 3/4; 7 results for control, results for new therapy; 8 hazard ratio for new therapy;
Publication DOI:10.1056/NEJMoa1709937; DOI:10.1056/NEJMoa1809697

6.2.2Advanced stages

6.2.2.1Molecular genetic stratification
6.2.2.1.1ALK inhibitors
6.2.2.1.1.1First line, molecular genetic stratification

Data are summarized in Figure 8, Figure 9 and Figure 10.

Figure 8: Alectinib in ALK+ NSCLC, first line  
Alectinib in ALK+ NSCLC, first line
1 N - number of patients; 2 RR - remission rate, in %; 3 PFS - progression-free survival, in months; 4 OS - overall survival, in months; 5 QoL – quality of life; 6 SAE – serious adverse events, CTCAE grade 3/4; 7 results for control, results for new therapy; 8 hazard ratio for new therapy; 9 n. s. - not significant; 10 n. r. – median not reached;
Publication: DOI:10.1056/NEJMoa1704795
Figure 9: Ceritinib in NSCLC, ALK+, first line  
Ceritinib in NSCLC, ALK+, first line
1 N - number of patients; 2 RR - remission rate, in %; 3 PFS - progression-free survival, in months; 4 OS - overall survival, in months; 5 QoL – quality of life; 6 SAE – serious adverse events, CTCAE grade 3/4; 7 results for control, results for new therapy; 8 hazard ratio for new therapy; 9 n. s. - not significant; 10 n. r. – median not reached;
Publication: DOI:10.1016/S0140-6736(17)30123-X
Figure 10: Crizotinib in NSCLC, ALK+, first line  
Crizotinib in NSCLC, ALK+, first line
1 N - number of patients; 2 RR - remission rate, in %; 3 PFS - progression-free survival, in months; 4 OS - overall survival, in months; 5 QoL – quality of life; 6 SAE – serious adverse events, CTCAE grade 3/4; 7 results for control, results for new therapy; 8 hazard ratio for new therapy; 9 n. s. - not significant; 10 n. r. – median not reached;
Publication: DOI:10.1056/NEJMoa1408440; DOI:10.1200/JCO.2017.77.4794
6.2.2.1.1.2Second line, molecular genetic stratification

Data are summarized in Figure 11, Figure 12, Figure 13 and Figure 14.

Figure 11: Alectinib in ALK+ NSCLC, second line  
Alectinib in ALK+ NSCLC, second line
1 N - number of patients; 2 RR - remission rate, in %; 3 PFS - progression-free survival, in months; 4 OS - overall survival, in months; 5 QoL – quality of life; 6 SAE – serious adverse events, CTCAE grade 3/4; 7 results for control, results for new therapy; 8 hazard ratio for new therapy; 9 n. s. - not significant; 10 n. r. – median not reached; 11 pemetrexed. docetaxel or ceritinib
Publication: DOI:10.1093/annonc/mdy121
Figure 12: Brigatinib in NSCLC, ALK+, second line  
Brigatinib in NSCLC, ALK+, second line
1 N - number of patients; 2 RR - remission rate, in %; 3 PFS - progression-free survival, in months; 4 OS - overall survival, in months; 5 QoL – quality of life; 6 SAE – serious adverse events, CTCAE grade 3/4; 7 results for control, results for new therapy; 8 hazard ratio for new therapy;
Publication: DOI:10.1200/JCO.2016.71.5904
Figure 13: Ceritinib in NSCLC, ALK+, second line  
Ceritinib in NSCLC, ALK+, second line
1 N - number of patients; 2 RR - remission rate, in %; 3 PFS - progression-free survival, in months; 4 OS - overall survival, in months; 5 QoL – quality of life; 6 SAE – serious adverse events, CTCAE grade 3/4; 7 results for control, results for new therapy; 8 hazard ratio for new therapy; 9 n. s. - not significant; 11 pemetrexed or docetaxel
Publication: DOI:10.1016/S1470-2045(17)30339-X
Figure 14: Crizotinib in NSCLC, ALK+, second line  
Crizotinib in NSCLC, ALK+, second line
1 N - number of patients; 2 RR - remission rate, in %; 3 PFS - progression-free survival, in months; 4 OS - overall survival, in months; 5 QoL – quality of life; 6 SAE – serious adverse events, CTCAE grade 3/4; 7 results for control, results for new therapy; 8 hazard ratio for new therapy; 9 n. s. - not significant;
Publication: DOI:10.1056/NEJMoa1214886
6.2.2.1.2BRAF inhibitors, first and second line

Data are summarized in Figure 15 and Figure 16.

Figure 15: Dabrafenib + Trametinib in NSCLC, BRAF V600E, first line  
Dabrafenib + Trametinib in NSCLC, BRAF V600E, first line
1 N - number of patients; 2 RR - remission rate, in %; 3 PFS - progression-free survival, in months; 4 OS – overall survival, in months; 5 QoL – quality of life; 6 SAE – serious adverse events, CTCAE grade 3/4; 7 results for control, results for new therapy; 8 hazard ratio for new therapy; 9 n. s. - not significant; 10 n. d. - not determined;
Publication: DOI:10.1016/S1470-2045(17)30679-4
Figure 16: Dabrafenib + Trametinib in NSCLC, BRAF V600E, second line  
Dabrafenib + Trametinib in NSCLC, BRAF V600E, second line
1 N - number of patients; 2 RR - remission rate, in %; 3 PFS - progression-free survival, in months; 4 OS – overall survival, in months; 5 QoL – quality of life; 6 SAE – serious adverse events, CTCAE grade 3/4; 7 results for control, results for new therapy; 8 hazard ratio for new therapy; 9 n. s. - not significant; 10 n. d. - not determined;
Publication: DOI:10.1016/S1470-2045(16)30146-2
6.2.2.1.3EGFR inhibitors
6.2.2.1.3.1First line, EGFR inhibitors

Data are summarized in Figure 17, Figure 18, Figure 19, Figure 20, Figure 21 and Figure 22.

Figure 17: Afatinib in EGFRmutated NSCLC, first line  
Afatinib in EGFRmutated NSCLC, first line
1 N - number of patients; 2 RR - remission rate, in %; 3 PFS - progression-free survival, in months; 4 OS – overall survival, in months; 5 QoL – quality of life; 6 SAE – serious adverse events, CTCAE grade 3/4; 7 results for control, results for new therapy; 8 hazard ratio for new therapy; 9 n. s. - not significant; 10 n. d. - not determined; CT - chemotherapy
Publication: DOI:10.1016/S1470-2045(13)70604-1; DOI:10.1016/S1470-2045(15)00026-1; DOI:10.1016/j.cllc.2018.03.009
Figure 18: Dacomitinib in NSCLC, EGFRmut, first line  
Dacomitinib in NSCLC, EGFRmut, first line
1 N - number of patients; 2 RR - remission rate, in %; 3 PFS - progression-free survival, in months; 4 OS – overall survival, in months; 5 QoL – quality of life; 6 SAE – serious adverse events, CTCAE grade 3/4; 7 results for control, results for new therapy; 8 hazard ratio for new therapy; 9 n. s. - not significant; 10 n. d. - not determined;
Publication: DOI:10.1016/S1470-2045(17)30608-3; DOI:10.1200/JCO.2018.78.7994
Figure 19: Erlotinib in NSCLC, EGFRmut, first line (OPTIMAL) 
Erlotinib in NSCLC, EGFRmut, first line (OPTIMAL)
1 N - number of patients; 2 RR - remission rate, in %; 3 PFS - progression-free survival, in months; 4 OS – overall survival, in months; 5 QoL – quality of life; 6 SAE – serious adverse events, CTCAE grade 3/4; 7 results for control, results for new therapy; 8 hazard ratio for new therapy; 9 n. s. - not significant; 10 n. d. - not determined;
Publication: DOI:10.1016/S1470-2045(11)70393-X
Figure 20: Erlotinib in NSCLC, EGFRmut, first line (EURTAC) 
Erlotinib in NSCLC, EGFRmut, first line (EURTAC)
1 N - number of patients; 2 RR - remission rate, in %; 3 PFS - progression-free survival, in months; 4 OS – overall survival, in months; 5 QoL – quality of life; 6 SAE – serious adverse events, CTCAE grade 3/4; 7 results for control, results for new therapy; 8 hazard ratio for new therapy; 9 n. s. - not significant; 10 n. d. - not determined;
Publication: DOI:10.1016/S1470-2045(11)70393-X
Figure 21: Gefitinib in NSCLC, EGFRmut, first line 
Gefitinib in NSCLC, EGFRmut, first line
1 N - number of patients; 2 RR - remission rate, in %; 3 PFS - progression-free survival, in months; 4 OS – overall survival, in months; 5 QoL – quality of life; 6 SAE – serious adverse events, CTCAE grade 3/4; 7 results for control, results for new therapy; 8 hazard ratio for new therapy; 9 n. s. - not significant; 10 n. d. - not determined;
Publication: DOI:10.1056/NEJMoa0810699; DOI:10.1200/JCO.2010.33.4235
Figure 22: Osimertinib in NSCLC, EGFRmut, first line 
Osimertinib in NSCLC, EGFRmut, first line
1 N - number of patients; 2 RR - remission rate, in %; 3 PFS - progression-free survival, in months; 4 OS – overall survival, in months; 5 QoL – quality of life; 6 SAE – serious adverse events, CTCAE grade 3/4; 7 results for control, results for new therapy; 8 hazard ratio for new therapy; 9 n. s. - not significant; 10 n. d. - not determined;
Publication: DOI:10.1056/NEJMoa1713137
6.2.2.1.3.2Second line, EGFR T790M

Data are summarized in Figure 23.

Figure 23: Osimertinib in NSCLC, EGFR T790M 
Osimertinib in NSCLC, EGFR T790M
1 N - number of patients; 2 RR - remission rate, in %; 3 PFS - progression-free survival, in months; 4 OS – overall survival, in months; 5 QoL – quality of life; 6 SAE – serious adverse events, CTCAE grade 3/4; 7 results for control, results for new therapy; 8 hazard ratio for new therapy; 9 n. s. - not significant; 10 n. d. - not determined;
Publication: DOI:10.1056/NEJMoa1411817; DOI:10.1056/NEJMoa1612674
6.2.2.1.4ROS1 inhibitors
6.2.2.1.4.1Crizotinib, ROS1 inhibitors

Data are summarized in Figure 24.

Figure 24: Crizotinib in NSCLC, ROS1+  
Crizotinib in NSCLC, ROS1+
1 N - number of patients; 2 RR - remission rate, in %; 3 PFS - progression-free survival, in months; 4 OS – overall survival rate after 12 months, in%; 5 QoL – quality of life; 6 SAE – serious adverse events, CTCAE grade 3/4; 7 results for new therapy; 8 hazard ratio for new therapy;
Publication: DOI:10.1056/NEJMoa1406766
6.2.2.1.4.2Others, ROS1 inhibitors

Other kinase inhibitors like ceritinib, cabozantinib, entrectinib and lorlatinib show effectivity in ROS-1 translocated NSCLC, but are not approved in the EU.

6.2.2.2No molecular genetic stratification
6.2.2.2.1Chemotherapy
6.2.2.2.1.1First line, no molecular genetic stratification

Cytostatic drugs are the backbone of systemic therapy in these patients. Data on the selection of platin derivates are summarized in Figure 25 and Figure 26, data on pemetrexed in Figure 27.

Figure 25: Platin derivates in NSCLC, advanced stages 
Platin derivates in NSCLC, advanced stages
1 N - number of patients; 2 RR - remission rate, in %; 3 PFS - progression-free survival, in months; 4 OS – overall survival, in months; 5 QoL – quality of life; 6 SAE – serious adverse events, CTCAE grade 3/4; 7 results for control, results for new therapy; 8 hazard ratio for new therapy (confidence interval);
Publication: DOI:10.1002/14651858.CD009256.pub2
Figure 26: Platin derivates in NSCLC, first line 
Platin derivates in NSCLC, first line
1 N - number of patients; 2 RR - remission rate, in %; 3 PFS - progression-free survival, in months; 4 OS – overall survival, in months, in %; 5 QoL – quality of life; 6 SAE – serious adverse events, CTCAE grade 3/4; 8 hazard ratio for new therapy (confidence interval); 9 gemcitabine, vinorelbine, docetaxel, paclitaxel, irinotecan, or pemetrexed;
Publication: DOI:10.1016/j.lungcan.2019.07.010
Figure 27: Pemetrexed in NSCLC, first line 
Pemetrexed in NSCLC, first line
1 N - number of patients; 2 RR - remission rate, in %; 3 PFS - progression-free survival, in months; 4 OS – overall survival, in months, in %; 5 QoL – quality of life; 6 SAE – serious adverse events, CTCAE grade 3/4; 7 results for control, results for new therapy; 8 hazard ratio for new therapy;
Publication: DOI:10.1200/JCO.2007.15.0375
6.2.2.2.1.2Second line, no molecular genetic stratification

Data on docetaxel are summarized in Figure 28.

Figure 28: Docetaxel in NSCLC, second line 
Docetaxel in NSCLC, second line
1 N - number of patients; 2 RR - remission rate, in %; 3 PFS - progression-free survival, in months; 4 OS – overall survival, in months, in %; 5 QoL – quality of life; 6 SAE – serious adverse events, CTCAE grade 3/4; 7 results for control, results for new therapy; 8 hazard ratio for new therapy;
Publication: DOI:10.1200/JCO.2000.18.12.2354
6.2.2.2.2Immunotherapy

Immune checkpoint inhibitors are approved as monotherapy and in combination with chemotherapy.

6.2.2.2.2.1First line, monotherapy

Data are summarized in Figure 29.

Figure 29: Pembrolizumab in NSCLC, PD-L1 ≥%, first line 
Pembrolizumab in NSCLC, PD-L1 ≥%, first line
1 N - number of patients; 2 RR - remission rate, in %; 3 PFS - progression-free survival, in months; 4 OS – overall survival, in months, in %; 5 QoL – quality of life; 6 SAE – serious adverse events, CTCAE grade 3/4; 7 results for control, results for new therapy; 8 hazard ratio for new therapy;
Publication: DOI:10.1056/NEJMoa1606774
6.2.2.2.2.2First line, combination therapy

Data are summarized in Figure 30, Figure 31 and Figure 32.

Figure 30: Atezolizumab in NSCLC, non-squamous, combination, first line  
Atezolizumab in NSCLC, non-squamous, combination, first line
1 N - number of patients; 2 RR - remission rate, in %; 3 PFS - progression-free survival, in months; 4 OS – overall survival, in months, in %; 5 QoL – quality of life; 6 SAE – serious adverse events, CTCAE grade 3/4; 7 results for control, results for new therapy; 8 hazard ratio for new therapy;
Publication: DOI:10.1056/NEJMoa1716948
Figure 31: Pembrolizumab in NSCLC, non-squamous, combination, first line 
Pembrolizumab in NSCLC, non-squamous, combination, first line
1 N - number of patients; 2 RR - remission rate, in %; 3 PFS - progression-free survival, in months; 4 OS – overall survival, in months, in %; 5 QoL – quality of life; 6 SAE – serious adverse events, CTCAE grade 3/4; 7 results for control, results for new therapy; 8 hazard ratio for new therapy;
Publication: DOI:10.1056/NEJMoa1801005
Figure 32: Pembrolizumab in NSCLC, squamous, combination, first line 
Pembrolizumab in NSCLC, squamous, combination, first line
1 N - number of patients; 2 RR - remission rate, in %; 3 PFS - progression-free survival, in months; 4 OS – overall survival, in months, in %; 5 QoL – quality of life; 6 SAE – serious adverse events, CTCAE grade 3/4; 7 results for control, results for new therapy; 8 hazard ratio for new therapy;
Publication: DOI:10.1056/NEJMoa1810865
6.2.2.2.2.3Second line, Immunotherapy

Data are summarized in Figure 33, Figure 34, Figure 35 and Figure 36.

Figure 33: Atezolizumab in NSCLC, second line 
Atezolizumab in NSCLC, second line
1 N - number of patients; 2 RR - remission rate, in %; 3 PFS - progression-free survival, in months; 4 OS – overall survival, in months, in %; 5 QoL – quality of life; 6 SAE – serious adverse events, CTCAE grade 3/4; 7 results for control, results for new therapy; 8 hazard ratio for new therapy; 11 docetaxel, pemetrexed or nivolumab;
Publication: DOI:10.1016/S0140-6736(16)32517-X
Figure 34: Nivolumab in NSCLC, non-squamous, second line 
Nivolumab in NSCLC, non-squamous, second line
1 N - number of patients; 2 RR - remission rate, in %; 3 PFS - progression-free survival, in months; 4 OS – overall survival, in months, in %; 5 QoL – quality of life; 6 SAE – serious adverse events, CTCAE grade 3/4; 7 results for control, results for new therapy; 8 hazard ratio for new therapy; 11 pemetrexed, gefitinib or crizotinib;
Publication: DOI:10.1056/NEJMoa1507643
Figure 35: Nivolumab in NSCLC, squamous, second line 
Nivolumab in NSCLC, squamous, second line
1 N - number of patients; 2 RR - remission rate, in %; 3 PFS - progression-free survival, in months; 4 OS – overall survival, in months, in %; 5 QoL – quality of life; 6 SAE – serious adverse events, CTCAE grade 3/4; 7 results for control, results for new therapy; 8 hazard ratio for new therapy; 11 docetaxel;
Publication: DOI:10.1056/NEJMoa1507643
Figure 36: Pembrolizumab in NSCLC, PD-L1 ≥%, second line 
Pembrolizumab in NSCLC, PD-L1 ≥%, second line
1 N - number of patients; 2 RR - remission rate, in %; 3 PFS - progression-free survival, in months; 4 OS – overall survival, in months, in %; 5 QoL – quality of life; 6 SAE – serious adverse events, CTCAE grade 3/4; 7 results for control, results for new therapy; 8 hazard ratio for new therapy; 11 pemetrexed, docetaxel or nivolumab;
Publication: DOI:10.1016/S0140-6736(15)01281-7
6.2.2.2.3Others
6.2.2.2.3.1First line, others

Data are summarized in Figure 37.

Figure 37: Bevacizumab in NSCLC, non-squamous, combination, first line  
Bevacizumab in NSCLC, non-squamous, combination, first line
1 N - number of patients; 2 RR - remission rate, in %; 3 PFS - progression-free survival, in months; 4 OS – overall survival, in months, in %; 5 QoL – quality of life; 6 SAE – serious adverse events, CTCAE grade 3/4; 7 results for control, results for new therapy; 8 hazard ratio for new therapy;
Publication: DOI:10.1056/NEJMoa061884
6.2.2.2.3.2Second line, others

Others including antiangiogenetic agents and tyrosine kinase inhibitors. Data are summarized in Figure 38, Figure 39, Figure 40 and Figure 41

Figure 38: Afatinib in NSCLC, squamous-cell carcinoma, first line  
Afatinib in NSCLC, squamous-cell carcinoma, first line
1 N - number of patients; 2 RR - remission rate, in %; 3 PFS - progression-free survival, in months; 4 OS – overall survival, in months, in %; 5 QoL – quality of life; 6 SAE – serious adverse events, CTCAE grade 3/4; 7 results for control, results for new therapy; 8 hazard ratio for new therapy; 11 docetaxel;
Publication: DOI:10.1016/S1470-2045(15)00006-6
Figure 39: Erlotinib in NSCLC, EGFRmut, second line 
Erlotinib in NSCLC, EGFRmut, second line
1 N - number of patients; 2 RR - remission rate, in %; 3 PFS - progression-free survival, in months; 4 OS – overall survival, in months, in %; 5 QoL – quality of life; 6 SAE – serious adverse events, CTCAE grade 3/4; 7 results for control, results for new therapy; 8 hazard ratio for new therapy;
Publication: DOI:10.1056/NEJMoa050753
Figure 40: Nintedanib in NSCLC, adenocarcinoma, combination, second line 
Nintedanib in NSCLC, adenocarcinoma, combination, second line
1 N - number of patients; 2 RR - remission rate, in %; 3 PFS - progression-free survival, in months; 4 OS – overall survival, in months, in %; 5 QoL – quality of life; 6 SAE – serious adverse events, CTCAE grade 3/4; 7 results for control, results for new therapy; 8 hazard ratio for new therapy;
Publication: DOI:10.1016/S1470-2045(13)70586-2
Figure 41: Ramucirumab in NSCLC, combination, second line 
Ramucirumab in NSCLC, combination, second line
1 N - number of patients; 2 RR - remission rate, in %; 3 PFS - progression-free survival, in months; 4 OS – overall survival, in months, in %; 5 QoL – quality of life; 6 SAE – serious adverse events, CTCAE grade 3/4; 7 results for control, results for new therapy; 8 hazard ratio for new therapy;
Publication: DOI:10.1016/S0140-6736(14)60845-X

7[Kapitel nicht relevant]

8[Kapitel nicht relevant]

9[Kapitel nicht relevant]

10[Kapitel nicht relevant]

11[Kapitel nicht relevant]

12[Kapitel nicht relevant]

13[Kapitel nicht relevant]

14Authors' Affiliations

Prof. Dr. med. Frank Griesinger
Pius Hospital Oldenburg
Universitätsklinik Innere Medizin-Onkologie
Klinik für Hämatologie und Onkologie
Georgenstr. 12
26121 Oldenburg
Dr. med. Wilfried Eberhardt
Universitätsklinikum Essen
Westdeutsches Tumorzentrum
Innere Klinik und Poliklinik
Hufelandstr. 55
45147 Essen
Dr. med. Martin Früh
Kantonsspital St. Gallen
Departement Innere Medizin
Fachbereich Onkologie/Hämatologie
CH-9007 St. Gallen
PD Dr. med. Oliver Gautschi
Luzerner Kantonsspital
Medizinische Onkologie
CH-6000 Luzern
Prim. Univ.-Prof. Dr. Wolfgang Hilbe
Wilhelminenspital Wien
1. Medizinische Abteilung
Zentrum für Onkologie und Hämatologie und Palliativstation
Montleartstr. 37
A-1160 Wien
Prof. Dr. med. Hans Hoffmann
Thoraxklinik am
Universitätsklinikum Heidelberg
Chirurgische Abteilung
Amalienstr. 5
69126 Heidelberg
Prof. Dr. med. Rudolf Maria Huber
Klinikum der Universität München-Innenstadt
Pneumologie
Ziemssenstr. 1
80336 München
Prof. Dr. med. Dr. rer. nat. Sonja Loges
Universitätsklinikum Hamburg-Eppendorf
II. Medizinischen Klinik und Poliklinik
AG Personalisierte Krebstherapie
Martinistr. 52
20246 Hamburg
PD Dr. med. Christoph Pöttgen
Universitätsklinikum Essen
Westdeutsches Tumorzentrum
Klinik für Strahlentherapie
Hufelandstr. 55
45147 Essen
Dr. Ron Pritzkuleit
Institut für Krebsepidemiologie
Krebsregister Schleswig-Holstein
Ratzeburger Allee 160
23538 Lübeck
Prof. Dr. med. Martin Reck
LungenClinic Grosshansdorf GmbH
Onkologischer Schwerpunkt
Wöhrendamm 80
22927 Großhansdorf
PD Dr. med. Niels Reinmuth
Asklepios Fachkliniken München-Gauting
Thorakale Onkologie
Robert-Koch-Allee 2
82131 München-Gauting
Dr. med. Martin Sebastian
Universitätsklinik Frankfurt
Medizinische Klinik II
Bereich Hämatologie/Onkologie
Theodor-Stern-Kai 7
60590 Frankfurt / Main
Prof. Dr. med. Dieter Ukena
Klinikum Bremen-Ost gGmbH
Klinik für Pneumologie und Beatmungsmedizin
Interdisziplinäres Lungenzentrum
Züricher Str. 40
28235 Bremen
Prof. Dr. med. Cornelius Waller
Medizinische Universitätsklinik Freiburg
Abteilung Hämatologie/Onkologie
Hugstetter Str. 55
79106 Freiburg
Prof. Dr. med. Jürgen Wolf
Universitätsklinik Köln
Centrum für Integrierte Onkologie
Kerpener Str. 62
50937 Köln
Prof. Dr. med. Martin Wolf
Klinikum Kassel
Medizinische Klinik IV
Hämatologie/Onkologie/Immunologie
Mönchebergstr. 41-43
34125 Kassel
Prof. Dr. med. Bernhard Wörmann
Amb. Gesundheitszentrum der Charité
Campus Virchow-Klinikum
Med. Klinik m.S. Hämatologie & Onkologie
Augustenburger Platz 1
13344 Berlin

15Disclosure of Potential Conflicts of Interest

according to the rules of the responsible Medical Societies.

Comments