Lung cancer stage 4

1. EGFR: Osimertinib, dacomitinib 1L

2. Afatinib (1L) with or without cetuximab ( after progression on Osimertinib)

3. ALK :Alectinib, Brigatinib, Lorlatinib all 1L, Lorlatinib can be 2L

4. Dabrafenib Trametinib can do 1L in BRAF  V600E mutated

5. 2nd line EGFR exon 20- amivantamab, mobocertinib

6.  KRAS G12 C 2L Sotorasib/ adagrasib

7. MET exon 14: 1L ok tepotinib, capmatinib, crizotinib

8. ROS 1: 1L Entrectenib ( better if brain mets) crizotinib, ceritinib. Lorlatinib can be used 2L.

9.  NTRK- 1L entrectenib, larotrectinib

10. HER 2 mutated- TDxd 2L

11. RET-1 L selpercatinib/ pralsetinib

Stage 4 lung cancer and IO

Cemiplimab monotherapy PDL1 50% or higher- median OS 26 m vs 13 months 

Cemiplimab with chemotherapy median OS 22 m vs 13 m. 

Both are category 1.

Cemiplimab with chemo: The most common (≥15%) adverse reactions were alopecia, musculoskeletal pain, nausea, fatigue, peripheral neuropathy, and decreased appetite.

The recommended cemiplimab-rwlc dose is 350 mg IV every 3 weeks. 

What subgroup of patients did the cemiplimab not benefit even though the overall population benefited? PDL1< 1%, women and non smokers. Underpowered to test the benefits.