Fig. 1

Advanced/metastatic NSCLC treatment algorithm. All treatment options shown may be appropriate and final selection of therapy should be individualized based on patient eligibility, prior treatment, and treatment availability at the treating physician’s discretion. These algorithms represent consensus sequencing suggestions by the panel. (1) All patients should be evaluated by a multidisciplinary team to determine histological subtype, identify targetable driver mutations, and perform PD-L1 testing. The Task Force unanimously agreed that all newly diagnosed patients should receive testing for PD-L1. (2) For patients with squamous NSCLC with TPS ≥ 50%, the Task Force supports pembrolizumab monotherapy first-line. When FDA approval is granted, the Task Force also supports pembrolizumab in combination with carboplatin & (nab-) paclitaxel in specific cases. (3) When approved by the FDA, the Task Force recommends combination pembrolizumab + pemetrexed & (nab-) paclitaxel first-line in patients with squamous histology and PD-L1 TPS < 50%. (4) In patients with non-squamous cell NSCLC tumors positive for EGFR, ALK, or ROS1 aberrations, appropriate targeted therapy should be administered. (5) Patients with squamous or non-squamous cell NSCLC who have progressed on platinum-containing chemotherapy and who have not previously received a checkpoint inhibitor should be considered for atezolizumab, nivolumab, or pembrolizumab. (6) The Task Force unanimously agreed that patients with non-squamous cell NSCLC without EGFR, ALK, or ROS1 aberrations and TPS < 50% should receive combination pembrolizumab + pemetrexed & carboplatin. (7) In patients with non-squamous cell NSCLC without EGFR, ALK, or ROS1 aberrations and TPS ≥ 50%, the Task Force recommends pembrolizumab monotherapy, but recognizes that combination pembrolizumab + pemetrexed & carboplatin can be appropriate in specific cases