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Update Summary

The following updates were made on February 4, 2021:

  • Nonsmall Cell Lung Cancer, Local Disease (Stages I-II): revised chemotherapy options and added osimertinib for EGFR+ disease

  • Nonsmall Cell Lung Cancer, Advanced (Stage IV) Disease and Relapsed Disease: added atezolizumab as option to PD-L1+ tumor section; added therapy options for MET and RET mutations in Targetable Genetic Mutation section

  • Small Cell Lung Cancer Table 146-6 and Extensive Disease section: added information about chemotherapy + durvalumab and lurbinectedin to table and text and updated second-line options for extensive disease


For the Chapter in the Schwinghammer, Handbook (not Wells Handbook anymore) please go to Chapter 62, Lung Cancer.



  • imageLung cancer is the leading cause of cancer deaths in both men and women in the United States. The overall 5-year survival rate for all types of lung cancer is about 18%.

  • imageCigarette smoking is responsible for most lung cancers. Smoking cessation should be encouraged, particularly in those receiving curative treatment (ie, Stages I to IIIA nonsmall cell lung cancer [NSCLC] and limited-stage small cell lung cancer [SCLC]).

  • imageNSCLC is the most commonly diagnosed type of lung cancer (about 80%). NSCLC typically has a slower growth rate and doubling time than SCLC.

  • imageAnnual screening with low-dose computed tomography (LDCT) imaging is currently recommended to identify lung cancer in high-risk individuals. However, ongoing studies are evaluating the optimal frequency and duration, and the effects of false-positive tests.

  • imageTreatment decisions for NSCLC are guided by the stage of disease, histology (squamous or nonsquamous), and molecular features (PD-L1, EGFR, ALK, BRAF, NTRK, and ROS1) of the tumor. Patient-specific factors (eg, performance status, comorbid conditions) must also be considered when developing a treatment plan.

  • imageThe treatment goals for SCLC lung cancer are cure (early-stage disease), prolonged survival, and maintenance of or improved quality of life through alleviation of symptoms.

  • imageEarly-stage lung cancer has the highest cure rates, following surgical resection of the tumor with or without chemotherapy for NSCLC and chemoradiotherapy for SCLC.

  • imageImmunotherapy with anti-programmed-death 1 (PD-1) targeting monoclonal antibody is recommended as first-line treatment of metastatic NSCLC that is PD-L1 positive. Immunotherapy can be added to a platinum doublet in patients with tumors that do not have a targetable genetic mutation and are PD-L1 negative. Patients with extensive-stage SCLC may receive immunotherapy either with a platinum doublet as first-line therapy or alone as second-line therapy.

  • imageTargeted therapies for advanced-stage NSCLC are preferred over platinum-based doublets or immunotherapy as first-line therapy in patients whose tumors harbor targetable genetic mutations such as EGFR exon 19 deletions or exon 21 (L858R) substitution mutations, or mutations in ALK, BRAF, NTRK, or ROS1.

  • imageOptimal patient care includes the management of adverse events from drug therapy. Adverse events may cause delays in treatment administration, increase morbidity, and contribute to treatment failure.

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