Lung Cancer (Non-Small Cell and Small Cell Lung Cancer)

Regimen Options

Last Updated: 11/03/2025 See Details

	Evolent Pathways	Febrile Neutropenic Risk	Emetogenic Risk	References
NON-SMALL CELL LUNG CANCER - NSCLC ECOG 0,1,2
Neoadjuvant (before surgery)	nivolumab, cisplatin or carboplatin and paclitaxel 3 cycles, any histology	Low	High	NCCN Guidelines® for Non-Small Cell Lung Cancer. V.3.2023. Forde PM et al. N Engl J Med 2022; 386:1973-1985
	nivolumab, cisplatin or carboplatin and gemcitabine 3 cycles, squamous only	Low	High	NCCN Guidelines® for Non-Small Cell Lung Cancer. V.3.2023. Forde PM et al. N Engl J Med 2022; 386:1973-1985
	nivolumab, cisplatin or carboplatin and pemetrexed 3 cycles, non-squamous only	Low	High	NCCN Guidelines® for Non-Small Cell Lung Cancer. V.3.2023. Forde PM et al. N Engl J Med 2022; 386:1973-1985
Adjuvant (for resected nsclc)	cisplatin and docetaxel	Intermediate	High	NCCN Guidelines® for Non-Small Cell Lung Cancer. V.2.2018. The International Adjuvant Lung Cancer Trial Collaborative Group. N Engl J Med 2004; 350:351-360
	cisplatin and etoposide	Intermediate	High	NCCN Guidelines® for Non-Small Cell Lung Cancer. V.2.2018. The International Adjuvant Lung Cancer Trial Collaborative Group. N Engl J Med 2004; 350:351-360
	cisplatin and gemcitabine	Low	High	NCCN Guidelines® for Non-Small Cell Lung Cancer. V.2.2018. The International Adjuvant Lung Cancer Trial Collaborative Group. N Engl J Med 2004; 350:351-360
	cisplatin and pemetrexed non-squamous only without EGFR mutation	Low	High	NCCN Guidelines® for Non-Small Cell Lung Cancer. V.2.2018. Scagliotti GV, et al. J Clin Oncol. 2008 Jul 20;26(21):3543-51.. Masters GA, et al. Lung Cancer. 2003;39(2):221-6. Kreuter M, et al. Ann Oncol. 2013 Apr;24(4):986-92.
	cisplatin and vinorelbine	Intermediate	High	NCCN Guidelines® for Non-Small Cell Lung Cancer. V.2.2018. Winton T, et al. N Engl J Med. 2005;352(25):2589-97. Arriagada R, et al. N Engl J Med. 2004;350(4):351-60. Douillard JY, et al. Lancet Oncol. 2006;7(9):719-27. Chang WJ, et al. Lung Cancer. 2014;84(1):51-5.
	osimertinib (EGFR mutation positive)	Low	Low	NCCN Guidelines® for Non-Small Cell Lung Cancer. V.2.2018. Wu YL et al. DOI: 10.1056/NEJMoa2027071
	alectinib (ALK positive)	Low	Low	NCCN Guidelines® for Non-Small Cell Lung Cancer. V.5.2024. Wu YL et al. N Engl J Med 2024;390:1265-1276
Perioperative (includes both neoadjuvant and adjuvant treatment approach)	pembrolizumab, cisplatin and gemcitabine squamous histology for 4 cycles as neoadjuvant then pembrolizumab for up to 13 cycles as adjuvant therapy	Low	High	NCCN Guidelines® for Non-Small Cell Lung Cancer. V.5.2024. Wakelee, H et al. N Engl J Med 2023;389:491-503. DOI: 10.1056/NEJMoa2302983
	pembrolizumab, cisplatin and pemetrexed non-squamous histology for 4 cycles as neoadjuvant then pembrolizumab for up to 13 cycles as adjuvant therapy	Low	High	NCCN Guidelines® for Non-Small Cell Lung Cancer. V.5.2024. Wakelee, H et al. N Engl J Med 2023;389:491-503. DOI: 10.1056/NEJMoa2302983
	durvalumab, carboplatin and paclitaxel squamous histology for 4 cycles before surgery, followed by adjuvant durvalumab for 12 cycles	Intermediate	High	NCCN Guidelines® for Non-Small Cell Lung Cancer. V.5.2024. Heymach JV et al. N Engl J Med 2023;389:1672-1684
	durvalumab, carboplatin and gemcitabine squamous histology for 4 cycles before surgery, followed by adjuvant durvalumab for 12 cycles	Intermediate	High	NCCN Guidelines® for Non-Small Cell Lung Cancer. V.5.2024. Heymach JV et al. N Engl J Med 2023;389:1672-1684
	durvalumab, carboplatin or cisplatin and pemetrexed non-squamous histology for 4 cycles before surgery, followed by adjuvant durvalumab for 12 cycles	Low	High	NCCN Guidelines® for Non-Small Cell Lung Cancer. V.5.2024. Heymach JV et al. N Engl J Med 2023;389:1672-1684
Chemoradiation	carboplatin and paclitaxel	Intermediate	High	NCCN Guidelines® for Non-Small Cell Lung Cancer. V.2.2018. Palma DA, et al. J Clin Oncol. 2015;33(26):2927. Steuer CE, et al. JAMA Oncol. 2017;3(8):1120-1129. Belani CP, et al. J Clin Oncol. 2005;23(25):5883-91.
	cisplatin and etoposide	Intermediate	High	NCCN Guidelines® for Non-Small Cell Lung Cancer. V.2.2018. Albain KS, et al. J Clin Oncol. 2002;20(16):3454-60. Steuer CE, et al. JAMA Oncol. 2017;3(8):1120-1129.
	carboplatin or cisplatin and pemetrexed	Low	High	NCCN Guidelines® for Non-Small Cell Lung Cancer. V.1.2024. Govindan R et al. J Clin Oncol. 2011 Aug 10; 29(23): 3120–3125.
CONSOLIDATION (UNRESECTABLE STAGE II OR III AND NO DISEASE PROGRESSION AFTER DEFINITIVE CONCURRENT CHEMORADIATION)
	durvalumab	Low	Low	NCCN Guidelines® for Non-Small Cell Lung Cancer. V.2.2018. Faivre-Finn C, Vicente D, Kurata T, et al. J Thorac Oncol . 2021 May;16(5):860-867. doi: 10.1016/j.jtho.2020.12.015.
ADVANCED/METASTATIC: EGFR EXON 19 DELETION, EXON 21 L858R, S768I, L861Q, and/or G719X MUTATION
Initial Therapy	osimertinib	Low	Low	NCCN Guidelines® for Non-Small Cell Lung Cancer. V.2.2018. Soria et al. N Engl J Med 2018; 378:113-125
	osimertinib, pemetrexed, and carboplatin or cisplatin Q3W for 4 cycles followed by osimertinib and pemetrexed EGFR exon 19 deletion or exon 21 L858R mutation	Low	High	NCCN Guidelines® for Non-Small Cell Lung Cancer. V.1.2025. Planchard D et al. N Engl J Med . 2023 Nov 23;389(21):1935-1948.
Subsequent Therapy	docetaxel or paclitaxel	Low	Low	NCCN Guidelines® for Non-Small Cell Lung Cancer. V.2.2018. Sequist LV et al. J Clin Oncol. 2013;31(27):3327-34.
	gemcitabine	Low	Low	NCCN Guidelines® for Non-Small Cell Lung Cancer. V.2.2018. Maemondo M, et al. N Engl J Med. 2010;362(25):2380-8.
	osimertinib No prior osimertinib or T790M positive	Low	Low	NCCN Guidelines® for Non-Small Cell Lung Cancer. V.2.2018. Mok et al. N Engl J Med 2017;376:629-40.
	carboplatin and paclitaxel	Intermediate	High	NCCN Guidelines® for Non-Small Cell Lung Cancer. V.2.2018. Ohe Y, et al. Ann Oncol. 2007;18(2):317-23. Strauss GM, et al. J Clin Oncol. 2008;26(31):5043-51.
	carboplatin and pemetrexed non-squamous only	Low	High	NCCN Guidelines® for Non-Small Cell Lung Cancer. V.2.2018. Scagliotti et al. J Clin Oncol 26:3543-3551. Kreuter et al. Annals of Oncology 24: 986–992, 2013
	cisplatin and pemetrexed non-squamous only	Low	High	NCCN Guidelines® for Non-Small Cell Lung Cancer. V.2.2018. Scagliotti et al. J Clin Oncol 26:3543-3551. Kreuter et al. Annals of Oncology 24: 986–992, 2013
	Best Supportive Care or Clinical Trial	NCCN Guidelines® for Supportive Care. ClinicalTrials.gov
ADVANCED/METASTATIC: EGFR EXON 20 INSERTION MUTATION
Initial Therapy	amivantamab-vmjw, carboplatin and pemetrexed	Low	High	NCCN Guidelines® for Non-Small Cell Lung Cancer. V.5.2024. Caicun Zhou, et al. N Engl J Med 2023;389:2039-2051.
Subsequent Therapy	amivantamab-vmjw	Low	Low	NCCN Guidelines® for Non-Small Cell Lung Cancer. V.2.2018. Park K, et al. J Clin Oncol. 2021 Aug 2;39(30):3391–3402.
	Best Supportive Care or Clinical Trial	NCCN Guidelines® for Supportive Care. ClinicalTrials.gov
ADVANCED/METASTATIC: ALK POSITIVE
Initial Therapy	alectinib	Low	Low	NCCN Guidelines® for Non-Small Cell Lung Cancer. V.2.2018. Ou SH, et al. J Clin Oncol. 2016;34(7):661-668. Shaw AT, et al. Lancet Oncol. 2016;17(2):234-242. Peters S, et al. N Engl J Med. 2017;377(9):829-838.
Subsequent Therapy	crizotinib 2nd Line	Low	Moderate	NCCN Guidelines® for Non-Small Cell Lung Cancer. V.2.2018. Kwak EL, et al. N Engl J Med. 2010;363(18):1693-703.
	docetaxel or paclitaxel	Low	Low	NCCN Guidelines® for Non-Small Cell Lung Cancer. V.2.2018. Fossella FV, et al. J Clin Oncol. 2000;18(12):2354-62. Fidias PM, et al. J Clin Oncol. 2009;27(4):591-8.
	gemcitabine	Low	Low	NCCN Guidelines® for Non-Small Cell Lung Cancer. V.2.2018. Maemondo M, et al. N Engl J Med. 2010;362(25):2380-8.
	carboplatin and paclitaxel	Intermediate	High	NCCN Guidelines® for Non-Small Cell Lung Cancer. V.2.2018. Ohe Y, et al. Ann Oncol. 2007;18(2):317-23. Strauss GM, et al. J Clin Oncol. 2008;26(31):5043-51.
	carboplatin and pemetrexed non-squamous only	Low	High	NCCN Guidelines® for Non-Small Cell Lung Cancer. V.2.2018. Scagliotti et al. J Clin Oncol 26:3543-3551. Kreuter et al. Annals of Oncology 24: 986–992, 2013
	cisplatin and pemetrexed non-squamous only	Low	High	NCCN Guidelines® for Non-Small Cell Lung Cancer. V.2.2018. Scagliotti et al. J Clin Oncol 26:3543-3551. Kreuter et al. Annals of Oncology 24: 986–992, 2013
	Best Supportive Care or Clinical Trial	NCCN Guidelines® for Supportive Care. ClinicalTrials.gov
ADVANCED/METASTATIC: ROS1 POSITIVE
Initial Therapy	crizotinib	Low	Moderate	NCCN Guidelines® for Non-Small Cell Lung Cancer. V.2.2018. Kwak EL, et al. N Engl J Med. 2010;363(18):1693-703.
	entrectinib	Low	Low	NCCN Guidelines® for Non-Small Cell Lung Cancer. V.2.2018. Drilon A et al. Cancer Discov. 2017 Apr;7(4):400-409.
Subsequent Therapy	docetaxel or paclitaxel	Low	Low	NCCN Guidelines® for Non-Small Cell Lung Cancer. V.2.2018. Fossella FV, et al. J Clin Oncol. 2000;18(12):2354-62. Fidias PM, et al. J Clin Oncol. 2009;27(4):591-8.
ADVANCED/METASTATIC: BRAF V600E MUTATION POSITIVE
Initial Therapy	dabrafenib and trametinib	Low	Low	NCCN Guidelines® for Non-Small Cell Lung Cancer. V.2.2018. NCCN Drugs & Biologics Compendium® Non-Small Cell Lung Cancer V.2.2018. Dabrafenib. Planchard D et al. https://doi.org/10.1016/j.jtho.2021.08.011
Subsequent Therapy	docetaxel or paclitaxel	Low	Moderate	NCCN Guidelines® for Non-Small Cell Lung Cancer. V.2.2018. Fossella FV, et al. J Clin Oncol. 2000;18(12):2354-62. Fidias PM, et al. J Clin Oncol. 2009;27(4):591-8.
	gemcitabine	Low	Low	NCCN Guidelines® for Non-Small Cell Lung Cancer. V.2.2018. Maemondo M, et al. N Engl J Med. 2010;362(25):2380-8.
	carboplatin and paclitaxel	Intermediate	High	NCCN Guidelines® for Non-Small Cell Lung Cancer. V.2.2018. Ohe Y, et al. Ann Oncol. 2007;18(2):317-23. Strauss GM, et al. J Clin Oncol. 2008;26(31):5043-51.
	carboplatin and pemetrexed non-squamous only	Low	High	NCCN Guidelines® for Non-Small Cell Lung Cancer. V.2.2018. Scagliotti et al. J Clin Oncol 26:3543-3551. Kreuter et al. Annals of Oncology 24: 986–992, 2013
	cisplatin and pemetrexed non-squamous only	Low	High	NCCN Guidelines® for Non-Small Cell Lung Cancer. V.2.2018. Scagliotti et al. J Clin Oncol 26:3543-3551. Kreuter et al. Annals of Oncology 24: 986–992, 2013
	Best Supportive Care or Clinical Trial	NCCN Guidelines® for Supportive Care. ClinicalTrials.gov
ADVANCED/METASTATIC: MESENCHYMAL-EPITHELIAL TRANSITION (MET) EXON 14 SKIPPING
Initial or Subsequent Therapy	capmatinib	Low	Low	NCCN Guidelines® for Non-Small Cell Lung Cancer. V.2.2018. Wolf J et al. DOI: 10.1200/JCO.2019.37.15_suppl.9004 Journal of Clinical Oncology 37, no. 15_suppl (May 20, 2019) 9004-9004.
	tepotinib	Low	Low	NCCN Guidelines® for Non-Small Cell Lung Cancer. V.2.2018. Paik PK et al. N Engl J Med 2020; 383:931-943
ADVANCED/METASTATIC: RET FUSION-POSITIVE
Initial or Subsequent Therapy	selpercatinib	Low	Low	NCCN Guidelines® for Non-Small Cell Lung Cancer. V.2.2018. Drilon A et al. DOI:https://doi.org/10.1016/j.jtho.2019.08.059
ADVANCED/METASTATIC: PD-L1 ≥ 50%
Initial Therapy	cemiplimab-rwlc negative for actionable molecular markers	Low	Low	NCCN Guidelines® for Non-Small Cell Lung Cancer. V.2.2018. Sezer A, et al. Lancet. 2021 Feb 13;397(10274):592-604.
Subsequent Therapy	docetaxel or paclitaxel	Low	Low	NCCN Guidelines® for Non-Small Cell Lung Cancer. V.2.2018. Fossella FV, et al. J Clin Oncol. 2000;18(12):2354-62. Fidias PM, et al. J Clin Oncol. 2009;27(4):591-8.
	gemcitabine	Low	Low	NCCN Guidelines® for Non-Small Cell Lung Cancer. V.2.2018. Maemondo M, et al. N Engl J Med. 2010;362(25):2380-8.
	carboplatin and paclitaxel	Intermediate	High	NCCN Guidelines® for Non-Small Cell Lung Cancer. V.2.2018. Ohe Y, et al. Ann Oncol. 2007;18(2):317-23. Strauss GM, et al. J Clin Oncol. 2008;26(31):5043-51.
	carboplatin and pemetrexed non-squamous only	Low	High	NCCN Guidelines® for Non-Small Cell Lung Cancer. V.2.2018. Scagliotti et al. J Clin Oncol 26:3543-3551. Kreuter et al. Annals of Oncology 24: 986–992, 2013
	cisplatin and pemetrexed non-squamous only	Low	High	NCCN Guidelines® for Non-Small Cell Lung Cancer. V.2.2018. Scagliotti et al. J Clin Oncol 26:3543-3551. Kreuter et al. Annals of Oncology 24: 986–992, 2013
	nivolumab if PD inhibitor naïve	Low	Low	NCCN Guidelines® for Non-Small Cell Lung Cancer. V.2.2018. Brahmer J et al. N Engl J Med 2015; 373:123-135
	atezolizumab if PD inhibitor naïve	Low	Low	NCCN Guidelines® for Non-Small Cell Lung Cancer. V.2.2018. Rittmeyer A et al. Lancet. 2017 Jan 21;389(10066):255-265.
	pembrolizumab PD-L1 expression levels ≥1% and no prior progression on a PD-1/PD-L1 inhibitor	Low	Low	NCCN Guidelines® for Non-Small Cell Lung Cancer. V.2.2018. Garon EB et al. J Clin Oncol . 2019 Oct 1;37(28):2518-2527
	Best Supportive Care or Clinical Trial	NCCN Guidelines® for Supportive Care. ClinicalTrials.gov
ADVANCED/METASTATIC: BIOMARKER NEGATIVE AND PD-L1 1-49% (NON-SQUAMOUS ONLY)
Initial Therapy	cisplatin, paclitaxel and cemiplimab-rwlc followed by cemiplimab-rwlc maintenance	Low	High	NCCN Guidelines® for Non-Small Cell Lung Cancer. V.11.2024. Gogishvili M et al. Nature Medicine volume 28, pages2374–2380 (2022)
	carboplatin, paclitaxel and cemiplimab-rwlc followed by cemiplimab-rwlc maintenance	Low	High	NCCN Guidelines® for Non-Small Cell Lung Cancer. V.11.2024. Gogishvili M et al. Nature Medicine volume 28, pages2374–2380 (2022)
	carboplatin, pemetrexed and cemiplimab-rwlc	Low	High	NCCN Guidelines® for Non-Small Cell Lung Cancer. v.1.2023. Gogishvili M et al. Nature Medicine volume 28, pages2374–2380 (2022)
	cisplatin, pemetrexed and cemiplimab-rwlc	Low	High	NCCN Guidelines® for Non-Small Cell Lung Cancer. v.1.2023. Gogishvili M et al. Nature Medicine volume 28, pages2374–2380 (2022)
	carboplatin or cisplatin and paclitaxel	Intermediate	High	NCCN Guidelines® for Non-Small Cell Lung Cancer. V.2.2018. Ohe Y, et al. Ann Oncol. 2007;18(2):317-23. Strauss GM, et al. J Clin Oncol. 2008;26(31):5043-51.
	carboplatin or cisplatin and gemcitabine	Low	High	NCCN Guidelines® for Non-Small Cell Lung Cancer. V.2.2018. Ohe Y, et al. Ann Oncol. 2007;18(2):317-23 Scagliottii GV et al. DOI: 10.1200/JCO.2007.15.0375 Journal of Clinical Oncology 26, no. 21 (July 20, 2008) 3543-3551.
	carboplatin or cisplatin and pemetrexed non-squamous only	Low	High	NCCN Guidelines® for Non-Small Cell Lung Cancer. V.2.2018. Scagliotti et al. J Clin Oncol 26:3543-3551. Kreuter et al. Annals of Oncology 24: 986–992, 2013
Subsequent Therapy	docetaxel or paclitaxel	Low	Low	NCCN Guidelines® for Non-Small Cell Lung Cancer. V.2.2018. Fossella FV, et al. J Clin Oncol. 2000;18(12):2354-62. Fidias PM, et al. J Clin Oncol. 2009;27(4):591-8.
	gemcitabine	Low	Low	NCCN Guidelines® for Non-Small Cell Lung Cancer. V.2.2018. Maemondo M, et al. N Engl J Med. 2010;362(25):2380-8.
	nivolumab *if PD inhibitor naïve	Low	Low	NCCN Guidelines® for Non-Small Cell Lung Cancer. V.2.2018. Brahmer J et al. N Engl J Med 2015; 373:123-135
	atezolizumab if PD inhibitor naïve	Low	Low	NCCN Guidelines® for Non-Small Cell Lung Cancer. V.2.2018. Rittmeyer A et al. Lancet. 2017 Jan 21;389(10066):255-265.
	pembrolizumab PD-L1 expression levels ≥1% and no prior progression on a PD-1/PD-L1 inhibitor	Low	Low	NCCN Guidelines® for Non-Small Cell Lung Cancer. V.2.2018. Garon EB et al. J Clin Oncol . 2019 Oct 1;37(28):2518-2527
	Best Supportive Care or Clinical Trial	NCCN Guidelines® for Supportive Care. ClinicalTrials.gov
ADVANCED/METASTATIC: BIOMARKER NEGATIVE AND PD-L1 1-49% (SQUAMOUS ONLY)
Initial Therapy	carboplatin, paclitaxel and cemiplimab-rwlc	Low	High	NCCN Guidelines® for Non-Small Cell Lung Cancer. v.1.2023. Gogishvili M et al. Nature Medicine volume 28, pages2374–2380 (2022)
	cisplatin, paclitaxel and cemiplimab-rwlc	Low	High	NCCN Guidelines® for Non-Small Cell Lung Cancer. v.1.2023. Gogishvili M et al. Nature Medicine volume 28, pages2374–2380 (2022)
	carboplatin or cisplatin and paclitaxel	Intermediate	High	NCCN Guidelines® for Non-Small Cell Lung Cancer. V.2.2018. Ohe Y, et al. Ann Oncol. 2007;18(2):317-23. Strauss GM, et al. J Clin Oncol. 2008;26(31):5043-51.
	carboplatin or cisplatin and gemcitabine	Low	High	NCCN Guidelines® for Non-Small Cell Lung Cancer. V.2.2018. Ohe Y, et al. Ann Oncol. 2007;18(2):317-23 Scagliottii GV et al. DOI: 10.1200/JCO.2007.15.0375 Journal of Clinical Oncology 26, no. 21 (July 20, 2008) 3543-3551.
Subsequent Therapy	docetaxel or paclitaxel	Low	Low	NCCN Guidelines® for Non-Small Cell Lung Cancer. V.2.2018. Fossella FV, et al. J Clin Oncol. 2000;18(12):2354-62. Fidias PM, et al. J Clin Oncol. 2009;27(4):591-8.
	gemcitabine	Low	Low	NCCN Guidelines® for Non-Small Cell Lung Cancer. V.2.2018. Maemondo M, et al. N Engl J Med. 2010;362(25):2380-8.
	nivolumab if PD inhibitor naïve	Low	Low	NCCN Guidelines® for Non-Small Cell Lung Cancer. V.2.2018. Brahmer J et al. N Engl J Med 2015; 373:123-135
	atezolizumab if PD inhibitor naïve	Low	Low	NCCN Guidelines® for Non-Small Cell Lung Cancer. V.2.2018. Rittmeyer A et al. Lancet. 2017 Jan 21;389(10066):255-265.
	pembrolizumab PD-L1 expression levels ≥1% and no prior progression on a PD-1/PD-L1 inhibitor	Low	Low	NCCN Guidelines® for Non-Small Cell Lung Cancer. V.2.2018. Garon EB et al. J Clin Oncol . 2019 Oct 1;37(28):2518-2527
	Best Supportive Care or Clinical Trial	NCCN Guidelines® for Supportive Care. ClinicalTrials.gov
ADVANCED/METASTATIC: BIOMARKER NEGATIVE AND PD-L1 <1% (NON-SQUAMOUS ONLY)
Initial Therapy	carboplatin, pemetrexed and pembrolizumab; followed by pembrolizumab up to 24 months (35 cycles)	Low	High	NCCN Guidelines® for Non-Small Cell Lung Cancer. V.2.2018. N Engl J Med. 2018 May 31;378(22):2078-2092.
	carboplatin, pemetrexed and pembrolizumab; followed by pembrolizumab and pemetrexed maintenance	Low	High	NCCN Guidelines® for Non-Small Cell Lung Cancer. V.2.2018. N Engl J Med. 2018 May 31;378(22):2078-2092.
	cisplatin, pemetrexed and pembrolizumab; followed by pembrolizumab	Low	High	NCCN Guidelines® for Non-Small Cell Lung Cancer. V.2.2018. N Engl J Med. 2018 May 31;378(22):2078-2092.
	cisplatin, pemetrexed and pembrolizumab; followed by pembrolizumab and pemetrexed maintenance	Low	High	NCCN Guidelines® for Non-Small Cell Lung Cancer. V.2.2018. N Engl J Med. 2018 May 31;378(22):2078-2092.
	carboplatin, paclitaxel and pembrolizumab; followed by pembrolizumab maintenance	Intermediate	High	NCCN Guidelines® for Non-Small Cell Lung Cancer. V.2.2018. Paz-Ares et al. N Engl J Med 2018; 379:2040-2051
	nivolumab and ipilimumab	Low	Low	NCCN Guidelines® for Non-Small Cell Lung Cancer. V.2.2018. Hellmann MD et al. N Engl J Med 2019; 381:2020-2031
	nivolumab and ipilimumab plus cisplatin or carboplatin and pemetrexed	Low	High	NCCN Guidelines® for Non-Small Cell Lung Cancer. V.2.2018. Paz-Ares L et al. Lancet Oncol . 2021 Feb;22(2):198-211
	carboplatin or cisplatin and paclitaxel	Intermediate	High	NCCN Guidelines® for Non-Small Cell Lung Cancer. V.2.2018. Ohe Y, et al. Ann Oncol. 2007;18(2):317-23. Strauss GM, et al. J Clin Oncol. 2008;26(31):5043-51.
	carboplatin or cisplatin and gemcitabine	Low	High	NCCN Guidelines® for Non-Small Cell Lung Cancer. V.2.2018. Ohe Y, et al. Ann Oncol. 2007;18(2):317-23 Scagliottii GV et al. DOI: 10.1200/JCO.2007.15.0375 Journal of Clinical Oncology 26, no. 21 (July 20, 2008) 3543-3551.
Subsequent Therapy	docetaxel or paclitaxel	Low	Low	NCCN Guidelines® for Non-Small Cell Lung Cancer. V.2.2018. Fossella FV, et al. J Clin Oncol. 2000;18(12):2354-62. Fidias PM, et al. J Clin Oncol. 2009;27(4):591-8.
	gemcitabine	Low	Low	NCCN Guidelines® for Non-Small Cell Lung Cancer. V.2.2018. Maemondo M, et al. N Engl J Med. 2010;362(25):2380-8.
	nivolumab if PD inhibitor naïve	Low	Low	NCCN Guidelines® for Non-Small Cell Lung Cancer. V.2.2018. Brahmer J et al. N Engl J Med 2015; 373:123-135
	atezolizumab if PD inhibitor naïve	Low	Low	NCCN Guidelines® for Non-Small Cell Lung Cancer. V.2.2018. Rittmeyer A et al. Lancet. 2017 Jan 21;389(10066):255-265.
	Best Supportive Care or Clinical Trial	NCCN Guidelines® for Supportive Care. ClinicalTrials.gov
ADVANCED/METASTATIC: BIOMARKER NEGATIVE AND PD-L1 <1% (SQUAMOUS ONLY)
Initial Therapy	carboplatin, paclitaxel and pembrolizumab; followed by pembrolizumab maintenance	Intermediate	High	NCCN Guidelines® for Non-Small Cell Lung Cancer. V.2.2018. Paz-Ares et al. N Engl J Med 2018; 379:2040-2051
	nivolumab and ipilimumab	Low	Low	NCCN Guidelines® for Non-Small Cell Lung Cancer. V.2.2018. Hellmann MD et al. N Engl J Med 2019; 381:2020-2031
	nivolumab and ipilimumab plus carboplatin and paclitaxel	Low	High	NCCN Guidelines® for Non-Small Cell Lung Cancer. V.2.2018. Paz-Ares L et al. Lancet Oncol . 2021 Feb;22(2):198-211
	carboplatin or cisplatin and paclitaxel	Intermediate	High	NCCN Guidelines® for Non-Small Cell Lung Cancer. V.2.2018. Ohe Y, et al. Ann Oncol. 2007;18(2):317-23. Strauss GM, et al. J Clin Oncol. 2008;26(31):5043-51.
	carboplatin or cisplatin and gemcitabine	Low	High	NCCN Guidelines® for Non-Small Cell Lung Cancer. V.2.2018. Ohe Y, et al. Ann Oncol. 2007;18(2):317-23 Scagliottii GV et al. DOI: 10.1200/JCO.2007.15.0375 Journal of Clinical Oncology 26, no. 21 (July 20, 2008) 3543-3551.
Subsequent Therapy	docetaxel or paclitaxel	Low	Low	NCCN Guidelines® for Non-Small Cell Lung Cancer. V.2.2018. Fossella FV, et al. J Clin Oncol. 2000;18(12):2354-62. Fidias PM, et al. J Clin Oncol. 2009;27(4):591-8.
	gemcitabine	Low	Low	NCCN Guidelines® for Non-Small Cell Lung Cancer. V.2.2018. Maemondo M, et al. N Engl J Med. 2010;362(25):2380-8.
	nivolumab if PD inhibitor naïve	Low	Low	NCCN Guidelines® for Non-Small Cell Lung Cancer. V.2.2018. Brahmer J et al. N Engl J Med 2015; 373:123-135
	atezolizumab if PD inhibitor naïve	Low	NCCN Guidelines® for Non-Small Cell Lung Cancer. V.2.2018. Rittmeyer A et al. Lancet. 2017 Jan 21;389(10066):255-265.
	Best Supportive Care or Clinical Trial	NCCN Guidelines® for Supportive Care. ClinicalTrials.gov
SMALL CELL LUNG CANCER (SCLC) AND LARGE CELL NEUROENDOCRINE
Initial Therapy - Limited	cisplatin and etoposide	Intermediate	High	NCCN Guidelines® for Small Cell Lung Cancer. V.3.2025. Turrisi AT, et al. N Engl J Med. 1999;340(4):265-71. Sundstrøm S, et al. J Clin Oncol. 2002;20(24):4665-72. Ihde DC, et al. J Clin Oncol. 1994;12(10):2022-34. Saito H, et al. J Clin Oncol. 2006;24(33):5247-52. Faivre-Finn C et al. Lancet Oncol 2017; 18: 1116–25
	cisplatin and etoposide with radiation	Intermediate	High	NCCN Guidelines® for Small Cell Lung Cancer. V.1.2018. Turrisi AT, et al. N Engl J Med. 1999;340(4):265-71. Sundstrøm S, et al. J Clin Oncol. 2002;20(24):4665-72. Ihde DC, et al. J Clin Oncol. 1994;12(10):2022-34. Saito H, et al. J Clin Oncol. 2006;24(33):5247-52. Faivre-Finn C et al. Lancet Oncol 2017; 18: 1116–25
	carboplatin and etoposide	Intermediate	High	NCCN Guidelines® for Small Cell Lung Cancer. V.1.2018. Skarlos DV, et al. Ann Oncol. 2001;12(9):1231-8. Okamoto H, et al. J Clin Oncol. 1999;17(11):3540-5.
	carboplatin and etoposide with radiation	Intermediate	High	NCCN Guidelines® for Small Cell Lung Cancer. V.1.2018. Skarlos DV, et al. Ann Oncol. 2001;12(9):1231-8. Okamoto H, et al. J Clin Oncol. 1999;17(11):3540-5.
	durvalumab consolidation after chemoradiotherapy	Low	Low	NCCN Guidelines® for Small Cell Lung Cancer. V.3.2025. Cheng Y, et al. N Engl J Med 2024;391:1313-1327.
Initial Therapy - Extensive	cisplatin and etoposide	Intermediate	High	NCCN Guidelines® for Small Cell Lung Cancer. V.2.2026. Turrisi AT, et al. N Engl J Med. 1999;340(4):265-71. Sundstrøm S, et al. J Clin Oncol. 2002;20(24):4665-72. Ihde DC, et al. J Clin Oncol. 1994;12(10):2022-34. Saito H, et al. J Clin Oncol. 2006;24(33):5247-52. Evans WK, et al. J Clin Oncol. 1985;3(11):1471-7.
	carboplatin and etoposide	Intermediate	High	NCCN Guidelines® for Small Cell Lung Cancer. V.1.2018. Skarlos DV, et al. Ann Oncol. 2001;12(9):1231-8. Okamoto H, et al. J Clin Oncol. 1999;17(11):3540-5.
	atezolizumab, carboplatin and etoposide followed by maintenance lurbinectedin and atezolizumab	Intermediate	High	NCCN Guidelines® for Small Cell Lung Cancer. V.2.2026. Horn L et al. N Engl J Med 2018; 379:2220-2229 Paz-Ares L et al. Lancet 2025; 405: 2129–43
	durvalumab, carboplatin or cisplatin and etoposide followed by maintenance durvalumab	Intermediate	High	NCCN Guidelines® for Small Cell Lung Cancer. V.2.2026. Paz-Ares L et al. Lancet . 2019 Nov 23;394(10212):1929-1939.
Subsequent Therapy	paclitaxel	Low	Low	NCCN Guidelines® for Small Cell Lung Cancer. V.1.2018. Smit EF, et al. Br J Cancer. 1998;77(2):347-51. Yamamoto N, et al. Anticancer Res. 2006;26(1B):777-81.
	docetaxel	Intermediate	Low	NCCN Guidelines® for Small Cell Lung Cancer. V.1.2018. Smyth JF, et al. Eur J Cancer. 1994;30A(8):1058-60. Hesketh PJ, et al. Cancer J Sci Am. 1999;5(4):237-41.
	topotecan	High	Low	NCCN Guidelines® for Small Cell Lung Cancer. V.1.2018. Eckardt JR, et al. J Clin Oncol. 2007;25(15):2086-92. von Pawel J, et al. J Clin Oncol. 1999;17(2):658-67. O’Brien ME, et al. J Clin Oncol. 2006;24(34):5441-7.
	irinotecan	Low	Moderate	NCCN Guidelines® for Small Cell Lung Cancer. V.1.2018. Masuda N, et al. J Clin Oncol. 1992;10(8):1225-9.
	tarlatamab	Low	Low	NCCN Guidelines® for Small Cell Lung Cancer. V.2.2026. Mountzios G, et al. N Engl J Med 2025;393:349-361.
	carboplatin and etoposide	Intermediate	High	NCCN Guidelines® for Small Cell Lung Cancer. V.1.2018. Skarlos DV, et al. Ann Oncol. 2001;12(9):1231-8. Okamoto H, et al. J Clin Oncol. 1999;17(11):3540-5.
	cisplatin and etoposide	Intermediate	High	NCCN Guidelines® for Small Cell Lung Cancer. V.1.2018. Turrisi AT, et al. N Engl J Med. 1999;340(4):265-71. Sundstrøm S, et al. J Clin Oncol. 2002;20(24):4665-72. Ihde DC, et al. J Clin Oncol. 1994;12(10):2022-34. Saito H, et al. J Clin Oncol. 2006;24(33):5247-52. Evans WK, et al. J Clin Oncol. 1985;3(11):1471-7.
	atezolizumab, carboplatin and etoposide followed by maintenance atezolizumab	Intermediate	High	NCCN Guidelines® for Small Cell Lung Cancer. V.1.2018. Horn L et al. N Engl J Med 2018; 379:2220-2229
	durvalumab, carboplatin or cisplatin and etoposide followed by maintenance durvalumab	Intermediate	High	NCCN Guidelines® for Small Cell Lung Cancer. V.3.2023. Paz-Ares L et al. Lancet . 2019 Nov 23;394(10212):1929-1939.
	Best Supportive Care or Clinical Trial	NCCN Guidelines® for Supportive Care.

NON-SMALL CELL LUNG CANCER - NSCLC ECOG 0,1,2

Neoadjuvant (before surgery)

Evolent Pathways

nivolumab, cisplatin or carboplatin and paclitaxel *3 cycles, any histology*

Febrile Neutropenic Risk

low

Emetogenic Risk

high

References

Evolent Pathways

nivolumab, cisplatin or carboplatin and gemcitabine *3 cycles, squamous only*

Febrile Neutropenic Risk

low

Emetogenic Risk

high

References

Evolent Pathways

nivolumab, cisplatin or carboplatin and pemetrexed *3 cycles, non-squamous only*

Febrile Neutropenic Risk

low

Emetogenic Risk

high

References

Adjuvant (for resected nsclc)

Evolent Pathways

cisplatin and docetaxel

Febrile Neutropenic Risk

intermediate

Emetogenic Risk

high

References

Evolent Pathways

cisplatin and etoposide

Febrile Neutropenic Risk

intermediate

Emetogenic Risk

high

References

Evolent Pathways

cisplatin and gemcitabine

Febrile Neutropenic Risk

low

Emetogenic Risk

high

References

Evolent Pathways

cisplatin and pemetrexed *non-squamous only* without EGFR mutation

Febrile Neutropenic Risk

low

Emetogenic Risk

high

References

Evolent Pathways

cisplatin and vinorelbine

Febrile Neutropenic Risk

intermediate

Emetogenic Risk

high

References

Evolent Pathways

osimertinib (EGFR mutation positive)

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

alectinib (ALK positive)

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Perioperative (includes both neoadjuvant and adjuvant treatment approach)

Evolent Pathways

pembrolizumab, cisplatin and gemcitabine *squamous histology* for 4 cycles as neoadjuvant then pembrolizumab for up to 13 cycles as adjuvant therapy

Febrile Neutropenic Risk

low

Emetogenic Risk

high

References

Evolent Pathways

pembrolizumab, cisplatin and pemetrexed *non-squamous histology* for 4 cycles as neoadjuvant then pembrolizumab for up to 13 cycles as adjuvant therapy

Febrile Neutropenic Risk

low

Emetogenic Risk

high

References

Evolent Pathways

durvalumab, carboplatin and paclitaxel *squamous histology* for 4 cycles before surgery, followed by adjuvant durvalumab for 12 cycles

Febrile Neutropenic Risk

intermediate

Emetogenic Risk

high

References

Evolent Pathways

durvalumab, carboplatin and gemcitabine *squamous histology* for 4 cycles before surgery, followed by adjuvant durvalumab for 12 cycles

Febrile Neutropenic Risk

intermediate

Emetogenic Risk

high

References

Evolent Pathways

durvalumab, carboplatin or cisplatin and pemetrexed *non-squamous histology* for 4 cycles before surgery, followed by adjuvant durvalumab for 12 cycles

Febrile Neutropenic Risk

low

Emetogenic Risk

high

References

Chemoradiation

Evolent Pathways

carboplatin and paclitaxel

Febrile Neutropenic Risk

intermediate

Emetogenic Risk

high

References

Evolent Pathways

cisplatin and etoposide

Febrile Neutropenic Risk

intermediate

Emetogenic Risk

high

References

Evolent Pathways

carboplatin or cisplatin and pemetrexed

Febrile Neutropenic Risk

low

Emetogenic Risk

high

References

CONSOLIDATION (UNRESECTABLE STAGE II OR III AND NO DISEASE PROGRESSION AFTER DEFINITIVE CONCURRENT CHEMORADIATION)

Evolent Pathways

durvalumab

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

ADVANCED/METASTATIC: EGFR EXON 19 DELETION, EXON 21 L858R, S768I, L861Q, and/or G719X MUTATION

Initial Therapy

Evolent Pathways

osimertinib

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

osimertinib, pemetrexed, and carboplatin or cisplatin Q3W for 4 cycles followed by osimertinib and pemetrexed *EGFR exon 19 deletion or exon 21 L858R mutation*

Febrile Neutropenic Risk

low

Emetogenic Risk

high

References

Subsequent Therapy

Evolent Pathways

docetaxel or paclitaxel

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

gemcitabine

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

osimertinib *No prior osimertinib or T790M positive*

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

carboplatin and paclitaxel

Febrile Neutropenic Risk

intermediate

Emetogenic Risk

high

References

Evolent Pathways

carboplatin and pemetrexed *non-squamous only*

Febrile Neutropenic Risk

low

Emetogenic Risk

high

References

Evolent Pathways

cisplatin and pemetrexed *non-squamous only*

Febrile Neutropenic Risk

low

Emetogenic Risk

high

References

Evolent Pathways

Best Supportive Care or Clinical Trial

References

ADVANCED/METASTATIC: EGFR EXON 20 INSERTION MUTATION

Initial Therapy

Evolent Pathways

amivantamab-vmjw, carboplatin and pemetrexed

Febrile Neutropenic Risk

low

Emetogenic Risk

high

References

Subsequent Therapy

Evolent Pathways

amivantamab-vmjw

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

Best Supportive Care or Clinical Trial

References

ADVANCED/METASTATIC: ALK POSITIVE

Initial Therapy

Evolent Pathways

alectinib

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Subsequent Therapy

Evolent Pathways

crizotinib *2nd Line*

Febrile Neutropenic Risk

low

Emetogenic Risk

moderate

References

Evolent Pathways

docetaxel or paclitaxel

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

gemcitabine

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

carboplatin and paclitaxel

Febrile Neutropenic Risk

intermediate

Emetogenic Risk

high

References

Evolent Pathways

carboplatin and pemetrexed *non-squamous only*

Febrile Neutropenic Risk

low

Emetogenic Risk

high

References

Evolent Pathways

cisplatin and pemetrexed *non-squamous only*

Febrile Neutropenic Risk

low

Emetogenic Risk

high

References

Evolent Pathways

Best Supportive Care or Clinical Trial

References

ADVANCED/METASTATIC: ROS1 POSITIVE

Initial Therapy

Evolent Pathways

crizotinib

Febrile Neutropenic Risk

low

Emetogenic Risk

moderate

References

Evolent Pathways

entrectinib

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Subsequent Therapy

Evolent Pathways

docetaxel or paclitaxel

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

ADVANCED/METASTATIC: BRAF V600E MUTATION POSITIVE

Initial Therapy

Evolent Pathways

dabrafenib and trametinib

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Subsequent Therapy

Evolent Pathways

docetaxel or paclitaxel

Febrile Neutropenic Risk

low

Emetogenic Risk

moderate

References

Evolent Pathways

gemcitabine

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

carboplatin and paclitaxel

Febrile Neutropenic Risk

intermediate

Emetogenic Risk

high

References

Evolent Pathways

carboplatin and pemetrexed *non-squamous only*

Febrile Neutropenic Risk

low

Emetogenic Risk

high

References

Evolent Pathways

cisplatin and pemetrexed *non-squamous only*

Febrile Neutropenic Risk

low

Emetogenic Risk

high

References

Evolent Pathways

Best Supportive Care or Clinical Trial

References

ADVANCED/METASTATIC: MESENCHYMAL-EPITHELIAL TRANSITION (MET) EXON 14 SKIPPING

Initial or Subsequent Therapy

Evolent Pathways

capmatinib

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

tepotinib

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

ADVANCED/METASTATIC: RET FUSION-POSITIVE

Initial or Subsequent Therapy

Evolent Pathways

selpercatinib

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

ADVANCED/METASTATIC: PD-L1 ≥ 50%

Initial Therapy

Evolent Pathways

cemiplimab-rwlc *negative for actionable molecular markers*

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Subsequent Therapy

Evolent Pathways

docetaxel or paclitaxel

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

gemcitabine

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

carboplatin and paclitaxel

Febrile Neutropenic Risk

intermediate

Emetogenic Risk

high

References

Evolent Pathways

carboplatin and pemetrexed *non-squamous only*

Febrile Neutropenic Risk

low

Emetogenic Risk

high

References

Evolent Pathways

cisplatin and pemetrexed *non-squamous only*

Febrile Neutropenic Risk

low

Emetogenic Risk

high

References

Evolent Pathways

nivolumab *if PD inhibitor naïve*

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

atezolizumab *if PD inhibitor naïve*

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

pembrolizumab *PD-L1 expression levels ≥1% and no prior progression on a PD-1/PD-L1 inhibitor*

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

Best Supportive Care or Clinical Trial

References

ADVANCED/METASTATIC: BIOMARKER NEGATIVE AND PD-L1 1-49% (NON-SQUAMOUS ONLY)

Initial Therapy

Evolent Pathways

cisplatin, paclitaxel and cemiplimab-rwlc followed by cemiplimab-rwlc maintenance

Febrile Neutropenic Risk

low

Emetogenic Risk

high

References

Evolent Pathways

carboplatin, paclitaxel and cemiplimab-rwlc followed by cemiplimab-rwlc maintenance

Febrile Neutropenic Risk

low

Emetogenic Risk

high

References

Evolent Pathways

carboplatin, pemetrexed and cemiplimab-rwlc

Febrile Neutropenic Risk

low

Emetogenic Risk

high

References

Evolent Pathways

cisplatin, pemetrexed and cemiplimab-rwlc

Febrile Neutropenic Risk

low

Emetogenic Risk

high

References

Evolent Pathways

carboplatin or cisplatin and paclitaxel

Febrile Neutropenic Risk

intermediate

Emetogenic Risk

high

References

Evolent Pathways

carboplatin or cisplatin and gemcitabine

Febrile Neutropenic Risk

low

Emetogenic Risk

high

References

Evolent Pathways

carboplatin or cisplatin and pemetrexed *non-squamous only*

Febrile Neutropenic Risk

low

Emetogenic Risk

high

References

Subsequent Therapy

Evolent Pathways

docetaxel or paclitaxel

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

gemcitabine

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

nivolumab *if PD inhibitor naïve

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

atezolizumab *if PD inhibitor naïve*

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

pembrolizumab *PD-L1 expression levels ≥1% and no prior progression on a PD-1/PD-L1 inhibitor*

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

Best Supportive Care or Clinical Trial

References

ADVANCED/METASTATIC: BIOMARKER NEGATIVE AND PD-L1 1-49% (SQUAMOUS ONLY)

Initial Therapy

Evolent Pathways

carboplatin, paclitaxel and cemiplimab-rwlc

Febrile Neutropenic Risk

low

Emetogenic Risk

high

References

Evolent Pathways

cisplatin, paclitaxel and cemiplimab-rwlc

Febrile Neutropenic Risk

low

Emetogenic Risk

high

References

Evolent Pathways

carboplatin or cisplatin and paclitaxel

Febrile Neutropenic Risk

intermediate

Emetogenic Risk

high

References

Evolent Pathways

carboplatin or cisplatin and gemcitabine

Febrile Neutropenic Risk

low

Emetogenic Risk

high

References

Subsequent Therapy

Evolent Pathways

docetaxel or paclitaxel

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

gemcitabine

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

nivolumab *if PD inhibitor naïve*

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

atezolizumab *if PD inhibitor naïve*

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

pembrolizumab *PD-L1 expression levels ≥1% and no prior progression on a PD-1/PD-L1 inhibitor*

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

Best Supportive Care or Clinical Trial

References

ADVANCED/METASTATIC: BIOMARKER NEGATIVE AND PD-L1 <1% (NON-SQUAMOUS ONLY)

Initial Therapy

Evolent Pathways

carboplatin, pemetrexed and pembrolizumab; followed by pembrolizumab up to 24 months (35 cycles)

Febrile Neutropenic Risk

low

Emetogenic Risk

high

References

Evolent Pathways

carboplatin, pemetrexed and pembrolizumab; followed by pembrolizumab and pemetrexed maintenance

Febrile Neutropenic Risk

low

Emetogenic Risk

high

References

Evolent Pathways

cisplatin, pemetrexed and pembrolizumab; followed by pembrolizumab

Febrile Neutropenic Risk

low

Emetogenic Risk

high

References

Evolent Pathways

cisplatin, pemetrexed and pembrolizumab; followed by pembrolizumab and pemetrexed maintenance

Febrile Neutropenic Risk

low

Emetogenic Risk

high

References

Evolent Pathways

carboplatin, paclitaxel and pembrolizumab; followed by pembrolizumab maintenance

Febrile Neutropenic Risk

intermediate

Emetogenic Risk

high

References

Evolent Pathways

nivolumab and ipilimumab

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

nivolumab and ipilimumab plus cisplatin or carboplatin and pemetrexed

Febrile Neutropenic Risk

low

Emetogenic Risk

high

References

Evolent Pathways

carboplatin or cisplatin and paclitaxel

Febrile Neutropenic Risk

intermediate

Emetogenic Risk

high

References

Evolent Pathways

carboplatin or cisplatin and gemcitabine

Febrile Neutropenic Risk

low

Emetogenic Risk

high

References

Subsequent Therapy

Evolent Pathways

docetaxel or paclitaxel

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

gemcitabine

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

nivolumab *if PD inhibitor naïve*

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

atezolizumab *if PD inhibitor naïve*

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

Best Supportive Care or Clinical Trial

References

ADVANCED/METASTATIC: BIOMARKER NEGATIVE AND PD-L1 <1% (SQUAMOUS ONLY)

Initial Therapy

Evolent Pathways

carboplatin, paclitaxel and pembrolizumab; followed by pembrolizumab maintenance

Febrile Neutropenic Risk

intermediate

Emetogenic Risk

high

References

Evolent Pathways

nivolumab and ipilimumab

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

nivolumab and ipilimumab plus carboplatin and paclitaxel

Febrile Neutropenic Risk

low

Emetogenic Risk

high

References

Evolent Pathways

carboplatin or cisplatin and paclitaxel

Febrile Neutropenic Risk

intermediate

Emetogenic Risk

high

References

Evolent Pathways

carboplatin or cisplatin and gemcitabine

Febrile Neutropenic Risk

low

Emetogenic Risk

high

References

Subsequent Therapy

Evolent Pathways

docetaxel or paclitaxel

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

gemcitabine

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

nivolumab *if PD inhibitor naïve*

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

atezolizumab *if PD inhibitor naïve*

Emetogenic Risk

low

References

Evolent Pathways

Best Supportive Care or Clinical Trial

References

SMALL CELL LUNG CANCER (SCLC) AND LARGE CELL NEUROENDOCRINE

Initial Therapy - Limited

Evolent Pathways

cisplatin and etoposide

Febrile Neutropenic Risk

intermediate

Emetogenic Risk

high

References

Evolent Pathways

cisplatin and etoposide with radiation

Febrile Neutropenic Risk

intermediate

Emetogenic Risk

high

References

Evolent Pathways

carboplatin and etoposide

Febrile Neutropenic Risk

intermediate

Emetogenic Risk

high

References

Evolent Pathways

carboplatin and etoposide with radiation

Febrile Neutropenic Risk

intermediate

Emetogenic Risk

high

References

Evolent Pathways

durvalumab *consolidation after chemoradiotherapy*

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Initial Therapy - Extensive

Evolent Pathways

cisplatin and etoposide

Febrile Neutropenic Risk

intermediate

Emetogenic Risk

high

References

Evolent Pathways

carboplatin and etoposide

Febrile Neutropenic Risk

intermediate

Emetogenic Risk

high

References

Evolent Pathways

atezolizumab, carboplatin and etoposide followed by maintenance lurbinectedin and atezolizumab

Febrile Neutropenic Risk

intermediate

Emetogenic Risk

high

References

Evolent Pathways

durvalumab, carboplatin or cisplatin and etoposide followed by maintenance durvalumab

Febrile Neutropenic Risk

intermediate

Emetogenic Risk

high

References

Subsequent Therapy

Evolent Pathways

paclitaxel

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

docetaxel

Febrile Neutropenic Risk

intermediate

Emetogenic Risk

low

References

Evolent Pathways

topotecan

Febrile Neutropenic Risk

high

Emetogenic Risk

low

References

Evolent Pathways

irinotecan

Febrile Neutropenic Risk

low

Emetogenic Risk

moderate

References

Evolent Pathways

tarlatamab

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

carboplatin and etoposide

Febrile Neutropenic Risk

intermediate

Emetogenic Risk

high

References

Evolent Pathways

cisplatin and etoposide

Febrile Neutropenic Risk

intermediate

Emetogenic Risk

high

References

Evolent Pathways

atezolizumab, carboplatin and etoposide followed by maintenance atezolizumab

Febrile Neutropenic Risk

intermediate

Emetogenic Risk

high

References

Evolent Pathways

durvalumab, carboplatin or cisplatin and etoposide followed by maintenance durvalumab

Febrile Neutropenic Risk

intermediate

Emetogenic Risk

high

References

Evolent Pathways

Best Supportive Care or Clinical Trial

References

	Regimen	Alternative	References
LOW VALUE REGIMENS (NON-PATHWAY) WITH SUPERIOR ALTERNATIVES
Subsequent therapy	lurbinectedin for small cell lung cancer	Alternatives: topotecan	A Review of Lurbinectedin and Topotecan
Initial therapy (EGFR Mutated)	erlotinib and ramucirumab or bevacizumab (nonsquamous)	Alternatives: osimertinib
Initial Therapy, (EGFR-mutated exon 19 deletion or L858R)	amivantamab plus lazertinib	Alternatives: osimertinib, pemetrexed and carboplatin or cisplatin followed by osimertinib and pemetrexed	Cho BC et al. N Engl J Med 2024;391:1486-1498 Planchard D et al. N Engl J Med. 2023 Nov 23;389(21):1935-1948.
Initial/Subsequent Therapy	carboplatin and albumin-bound paclitaxel (Abraxane)	Alternatives: carboplatin + paclitaxel	A Review Of Nab-Paclitaxel (Abraxane)
Initial/Subsequent Therapy	carboplatin, albumin-bound paclitaxel (Abraxane) and pembrolizumab (squamous)	Alternatives: carboplatin + paclitaxel + pembrolizumab	A Review Of Nab-Paclitaxel (Abraxane)
Initial Therapy	tremelimumab-actl, durvalumab, carboplatin and albumin-bound paclitaxel (Abraxane)	Alternatives: carboplatin + paclitaxel + pembrolizumab (squamous) or carboplatin + pemetrexed + pembrolizumab (non-squamous)	A Review Of Nab-Paclitaxel (Abraxane)
Subsequent Therapy	albumin-bound paclitaxel (Abraxane)	Alternatives: paclitaxel	A Review Of Nab-Paclitaxel (Abraxane)
Initial therapy, (PD-L1 ≥50%)	nivolumab and ipilimumab with or without carboplatin and paclitaxel (non-squamous and squamous)	Alternatives: pembrolizumab	A Review of Nivolumab + Ipilimumab
Initial therapy, (PD-L1 ≥50%)	nivolumab, ipilimumab, pemetrexed and (carboplatin or cisplatin) (nonsquamous)	Alternatives: pembrolizumab	A Review of Nivolumab + Ipilimumab
Initial therapy, (PD-L1 1-49%)	nivolumab and ipilimumab with or without carboplatin and paclitaxel (squamous)	Alternatives: carboplatin + paclitaxel + pembrolizumab	A Review of Nivolumab + Ipilimumab
Initial therapy, (PD-L1 1-49%)	nivolumab and ipilimumab and pemetrexed and carboplatin or cisplatin (non-squamous)	Alternatives: carboplatin + pemetrexed + pembrolizumab	A Review of Nivolumab + Ipilimumab
Initial therapy	bevacizumab, carboplatin and paclitaxel (non-squamous)	Alternatives: carboplatin + paclitaxel
Initial therapy	bevacizumab, carboplatin and pemetrexed	Alternatives: carboplatin + pemetrexed
Initial therapy	bevacizumab, cisplatin and pemetrexed	Alternatives: cisplatin + pemetrexed
Subsequent Therapy	ramucirumab and docetaxel	Alternatives: Docetaxel	A Review of Ramucirumab and Docetaxel

LOW VALUE REGIMENS (NON-PATHWAY) WITH SUPERIOR ALTERNATIVES

Subsequent therapy

Regimen

** lurbinectedin ** for small cell lung cancer

References

Initial therapy (EGFR Mutated)

Regimen

** erlotinib and ramucirumab or bevacizumab ** (nonsquamous)

Initial Therapy, (EGFR-mutated exon 19 deletion or L858R)

Regimen

amivantamab plus lazertinib

References

Initial/Subsequent Therapy

Regimen

** carboplatin and albumin-bound paclitaxel (Abraxane) **

References

Initial/Subsequent Therapy

Regimen

** carboplatin, albumin-bound paclitaxel (Abraxane) and pembrolizumab ** (squamous)

References

Initial Therapy

Regimen

** tremelimumab-actl, durvalumab, carboplatin and albumin-bound paclitaxel (Abraxane) **

References

Subsequent Therapy

Regimen

** albumin-bound paclitaxel (Abraxane) **

References

Initial therapy, (PD-L1 ≥50%)

Regimen

** nivolumab and ipilimumab with or without carboplatin and paclitaxel** (non-squamous and squamous)

References

Initial therapy, (PD-L1 ≥50%)

Regimen

** nivolumab, ipilimumab, pemetrexed and (carboplatin or cisplatin) ** (nonsquamous)

References

Initial therapy, (PD-L1 1-49%)

Regimen

** nivolumab and ipilimumab with or without carboplatin and paclitaxel ** (squamous)

References

Initial therapy, (PD-L1 1-49%)

Regimen

** nivolumab and ipilimumab and pemetrexed and carboplatin or cisplatin ** (non-squamous)

References

Initial therapy

Regimen

** bevacizumab, carboplatin and paclitaxel ** (non-squamous)

Initial therapy

Regimen

** bevacizumab, carboplatin and pemetrexed **

Initial therapy

Regimen

** bevacizumab, cisplatin and pemetrexed **

Subsequent Therapy

Regimen

** ramucirumab and docetaxel **

References

Pathways and Low-Value Regimens

Lung Cancer (Non-Small Cell and Small Cell Lung Cancer)