Lung SACT Regimens

The information contained in these regimens is a statement of consensus of NCCP and ISMO or IHS professionals regarding their views of currently accepted approaches to treatment. Any clinician seeking to apply or consult these documents is expected to use independent medical judgement in the context of individual clinical circumstances to determine any patient's care or treatment. The treatment regimen to be used should take into account factors such as histology, molecular pathology, age, performance status, co-morbidities and the patient’s preference. Each treatment regimen has advantages and disadvantages, and there may be more than one good option. In addition, treatment choices can change over time as more evidence becomes available. Use of these documents is the responsibility of the prescribing clinician and is subject to the HSE.ie terms of use.

Please email any comments or feedback on these regimens to oncologydrugs@cancercontrol.ie.

For information on open clinical trials please refer to the Cancer Trials Ireland website and also to basket trials.

Lung Chemotherapy Regimens

Regimen Name	Indication
Afatinib Monotherapy Regimen	00221a Treatment of EGFR TKI- naïve adult patients with locally advanced or metastatic NSCLC with activating EGFR mutation(s).
Alectinib Monotherapy Regimen	00401a Treatment of adult patients with anaplastic lymphoma kinase (ALK)-positive advanced non-small cell lung cancer (NSCLC) previously treated with crizotinib. 00401b As monotherapy is indicated for the first-line treatment of adult patients with anaplastic lymphoma kinase (ALK)-positive advanced non-small cell lung cancer (NSCLC)
Atezolizumab Monotherapy - 21 day Regimen	00544a Treatment of adult patients with locally advanced or metastatic non-small cell lung cancer (NSCLC) after prior chemotherapy. 00544d first-line treatment of adult patients with metastatic non-small cell lung cancer (NSCLC) whose tumours have a PDL1 expression ≥ 50% tumour cells (TC) or ≥ 10% tumour-infiltrating immune cells (IC) and who do not have EGFR mutant or ALK-positive NSCLC. 00544e Adjuvant treatment following complete resection and platinum-based chemotherapy for adult patients with non-small cell lung cancer (NSCLC) with a high risk of recurrence whose tumours have PD-L1 expression on ≥50% of tumour cells and who do not have EGFR mutant or ALK-positive mutations.
Atezolizumab 1680mg Monotherapy – 28 Day Regimen	00593a Treatment of adult patients with locally advanced or metastatic non-small cell lung cancer (NSCLC) after prior chemotherapy. 00593d First-line treatment of adult patients with metastatic non-small cell lung cancer (NSCLC) whose tumours have a PDL1 expression ≥ 50% tumour cells (TC) or ≥ 10% tumour-infiltrating immune cells (IC) and who do not have EGFR mutant or ALK-positive NSCLC. 00593e For the maintenance treatment of adult patients with extensive-stage small cell lung cancer (ES-SCLC), where this is a continuation of treatment for patients who have completed the induction chemotherapy component of the treatment. 00593f Adjuvant treatment following complete resection and platinum-based chemotherapy for adult patients with non-small cell lung cancer (NSCLC) with a high risk of recurrence whose tumours have PD-L1 expression on ≥50% of tumour cells and who do not have EGFR mutant or ALK-positive mutations.
Atezolizumab 840mg Monotherapy - 14 day Regimen	00592d As monotherapy for the first-line treatment of adult patients with metastatic non-small cell lung cancer (NSCLC) whose tumours have a PDL1 expression ≥ 50% tumour cells (TC) or ≥ 10% tumour-infiltrating immune cells (IC) and who do not have EGFR mutant or ALK-positive NSCLC. 00592e Adjuvant treatment following complete resection and platinum-based chemotherapy for adult patients with non-small cell lung cancer (NSCLC) with a high risk of recurrence whose tumours have PD-L1 expression on ≥50% of tumour cells and who do not have EGFR mutant or ALK-positive mutations.
Atezolizumab 1200mg, CARBOplatin AUC 5 and Etoposide 100mg/m2 Therapy Regimen	00689a First-line treatment of adult patients with extensive-stage small cell lung cancer (ES-SCLC).
Bevacizumab 7.5 mg/kg –21 days Regimen	00214b In addition to platinum-based chemotherapy is indicated for first-line treatment of adult patients with unresectable advanced, metastatic or recurrent non-small cell lung cancer (NSCLC) other than predominantly squamous cell histology.
Bevacizumab 15mg/kg Therapy- 21 day Regimen	00215f In addition to platinum-based chemotherapy is indicated for first-line treatment of adult patients with unresectable advanced, metastatic or recurrent non-small cell lung cancer (NSCLC) other than predominantly squamous cell histology. 00215g In combination with erlotinib is indicated for the first-line treatment of adult patients with unresectable advanced, metastatic or recurrent non-squamous cell lung cancer with Epidermal Growth Factor (EGFR) activating mutations.
Brigatinib Therapy Regimen	00562a For the treatment of adult patients with anaplastic lymphoma kinase (ALK) positive advanced non-small cell lung cancer (NSCLC) previously treated with crizotinib. 00562b Monotherapy for the treatment of adult patients with anaplastic lymphoma kinase (ALK) positive advanced non small cell lung cancer (NSCLC) previously not treated with an ALK inhibitor.
CARBOplatin (AUC5) and Etoposide 100mg/m² Therapy-21 days Regimen	00271a Small cell lung cancer (SCLC) extensive disease.
CARBOplatin (AUC 3), Etoposide (50mg/m2) and Thoracic Radiotherapy (TRT) -28 day Regimen	00561a Stage III Non Small cell lung cancer (NSCLC) in patients not suitable for treatment with CISplatin
CARBOplatin and Oral Etoposide Therapy-21 days Regimen	00319a Small cell lung cancer (SCLC) extensive disease.
CARBOplatin (AUC6) and PACLitaxel 200mg/m² Therapy* Regimen	00304a Adjuvant Treatment of Stage I,II and IIIA Non Small Cell Lung Cancer( NSCLC)^* 00304b Treatment of locally advanced, recurrent or metastatic NSCLC^* 00304c In combination with nivolumab for the neoadjuvant treatment of resectable NSCLC at high risk of recurrence in adult patients whose tumours have PD-L1 expression ≥ 1%
Weekly CARBOplatin (AUC2) and PACLitaxel 50mg/m² Therapy with Radiotherapy Regimen	00309a Stage III Non small cell lung cancer (NSCLC)*
CARBOplatin and vinORELbine Therapy-21 Day Regimen	00614a Treatment of locally advanced, recurrent or metastatic non-small cell lung cancer (NSCLC) in patients not suitable for treatment with CISplatin.
Ceritinib Monotherapy Regimen	00340a Treatment of adult patients with anaplastic lymphoma kinase (ALK)-positive advanced non-small cell lung cancer (NSCLC) previously treated with crizotinib.
CISplatin and Etoposide Regimen	00280a Small cell lung cancer (SCLC) extensive disease
CISplatin (75mg/m2) + Etoposide (100mg/m2) + Radiotherapy (RT) - 21 day Regimen	00279a Small cell lung cancer (SCLC) limited disease
CISplatin (50mg/m²) and Etoposide (50mg/m²) and Thoracic Radiotherapy (TRT) -28 day Regimen	00456a Stage III Non Small cell lung cancer (NSCLC).
Crizotinib Monotherapy Regimen	00243a Treatment of adults with previously treated ALK-positive advanced NSCLC 00243b The treatment of adults with ROS1-positive advanced non-small cell lung cancer (NSCLC) 00243c First-line treatment of adults with anaplastic lymphoma kinase (ALK)-positive advanced non-small cell lung cancer (NSCLC)
Dacomitinib Monotherapy Regimen	00565a Monotherapy, for the first-line treatment of adult patients with locally advanced or metastatic non-small cell lung cancer (NSCLC) with epidermal growth factor receptor (EGFR)-activating mutations
DOCEtaxel Monotherapy 75mg/m² – 21 day cycle Regimen	00203a Treatment of locally advanced or metastatic NSLC after failure of prior chemotherapy
Durvalumab 10mg/kg Monotherapy-14 day Regimen	00576a As monotherapy is indicated for the treatment of locally advanced, unresectable NSCLC in adults whose tumours express PD-L1 ≥1% on tumour cells and whose disease has not progressed following platinum-based chemo-radiation therapy (CRT).
Durvalumab 1500mg Monotherapy-28 day Regimen	00655a As monotherapy is indicated for the treatment of locally advanced, unresectable NSCLC in adults whose tumours express PD-L1 ≥1% on tumour cells and whose disease has not progressed following platinum-based chemo-radiation therapy (CRT)
Entrectinib Therapy Regimen	00702a As monotherapy for the treatment of adult patients with ROS1-positive, advanced non-small cell lung cancer (NSCLC) not previously treated with ROS1 inhibitors
Erlotinib Monotherapy Regimen	00219a First-line treatment of patients with locally advanced or metastatic non- small cell lung cancer (NSCLC) with EGFR activating mutations. 00219b Switch maintenance treatment in patients with locally advanced or metastatic NSCLC with EGFR activating mutations and stable disease after first-line chemotherapy. 00219c Treatment of patients with locally advanced or metastatic NSCLC after failure of at least one prior chemotherapy regimen.
Oral Etoposide Therapy Regimen	00388a Small cell lung cancer (SCLC) extensive disease in patients unsuitable for intravenous or combination chemotherapy.
Gefitinib Monotherapy Regimen	00220a Treatment of adult patients with locally advanced or metastatic non-small cell lung cancer (NSCLC) with activating mutations of EGFR-TK
Gemcitabine 1000mg/m² Monotherapy- 28 day Regimen	00284b Treatment of elderly patients or patients with ECOG =2 with locally advanced or metastatic non-small cell lung cancer (NSCLC)
Gemcitabine (1000mg/m²) and CARBOplatin (AUC5) Therapy-21 day Regimen	00310b Treatment of patients with locally advanced, recurrent or metastatic non small cell lung cancer (NSCLC)^* 00310c In combination with nivolumab for the neoadjuvant treatment of resectable NSCLC at high risk of recurrence in adult patients whose tumours have PD-L1 expression ≥ 1%
Gemcitabine (1250mg/m²) and CISplatin 75mg/m²Therapy-21day Regimen	00281a Treatment of patients with locally advanced or metastatic non-small cell lung cancer (NSCLC) 00281b In combination with nivolumab for the neoadjuvant treatment of resectable NSCLC at high risk of recurrence in adult patients whose tumours have PD-L1 expression ≥ 1%
Lorlatinib therapy Regimen	00570a As monotherapy for the treatment of adult patients with anaplastic lymphoma kinase (ALK)-positive advanced non-small cell lung cancer (NSCLC), following disease progression on (i) alectinib or ceritinib as the first ALK-targeted treatment or (ii) crizotinib and at least one other ALK-targeted treatment 00570b As monotherapy for the treatment of adult patients with ALK-positive advanced NSCLC previously not treated with an ALK inhibitor.
Nintedanib Therapy Regimen	00372a In combination with docetaxel for the treatment of adult patients with locally advanced, metastatic of stage IIIB or IV, or locally recurrent NSCLC of adenocarcinoma tumour histology after first-line chemotherapy.
Nivolumab 360mg and Chemotherapy Regimen	00849a Nivolumab in combination with platinum-based chemotherapy for the neoadjuvant treatment of resectable non-small cell lung cancer at high risk of recurrence in adult patients whose tumours have PD-L1 expression ≥ 1%
Nivolumab Monotherapy 240mg-14 days Regimen	00483e As monotherapy for the treatment of locally advanced or metastatic non-small cell lung cancer (NSCLC) after prior chemotherapy in adults.
Nivolumab Monotherapy 480mg-28 days Regimen	00484f As monotherapy for the treatment of locally advanced or metastatic non small cell lung cancer (NSCLC) after prior chemotherapy in adults.
Nivolumab, ipilimumab, CARBOplatin and PACLitaxel Therapy Regimen	00712a First-line treatment of metastatic squamous non-small cell lung cancer (NSCLC) in adults whose tumours have no sensitising EGFR mutation or ALK translocation.
Nivolumab, ipilimumab, PEMEtrexed and CARBOplatin Therapy Regimen	00713a First-line treatment of metastatic non-squamous non-small cell lung cancer (NSCLC) in adults whose tumours have no sensitising EGFR mutation or ALK translocation.
Nivolumab, ipilimumab, PEMEtrexed and CISplatin Therapy Regimen	00714a First-line treatment of metastatic non-squamous non-small cell lung cancer (NSCLC) in adults whose tumours have no sensitising EGFR mutation or ALK translocation.
Nivolumab 360mg and Ipilimumab 1mg/kg Therapy Regimen	00792 Nivolumab in combination with ipilimumab for the first-line treatment of adult patients with unresectable malignant pleural mesothelioma
Osimertinib Monotherapy Regimen	00353a Treatment of adult patients with locally advanced or metastatic epidermal growth factor receptor (EGFR) T790M mutation-positive non-small cell lung cancer (NSCLC) 00353b First-line treatment of adult patients with locally advanced or metastatic non-small cell lung cancer (NSCLC) with activating epidermal growth factor receptor (EGFR) mutations 00353c As monotherapy for adjuvant treatment after complete tumour resection in adult patients with stage IB-IIIA Non-Small Cell Lung Cancer (NSCLC) whose tumour has epidermal growth factor receptor (EGFR) exon 19 deletions (Ex19del) or exon 21 (L858R) substitution mutations.
PACLitaxel Monotherapy 80mg/m2 Day 1, 8, 15 and 22 – 28 Day Regimen	00226d Relapsed or refractory small cell lung cancer.
PACLitaxel 80mg/m2 Day 1, 8 and 15 Monotherapy-28 Day Regimen	00621d Relapsed or refractory small cell lung cancer.
Pembrolizumab 200mg Monotherapy Regimen	00455a First-line treatment of metastatic non-small cell lung carcinoma (NSCLC) in adults whose tumours express PD-L1 with a ≥50% tumour proportion score (TPS) with no EGFR or ALK positive tumour mutations.
Pembrolizumab 400 mg monotherapy Regimen	00558a First-line treatment of metastatic non-small cell lung carcinoma (NSCLC) in adults whose tumours express PD-L1 with a ≥50% tumour proportion score (TPS) with no EGFR mutations or ALK translocations.
Pembrolizumab, PACLitaxel and CARBOplatin (AUC 6) Therapy Regimen	00579a Pembrolizumab In Combination with CARBOplatin and PACLitaxel for the first-line treatment of Patients with metastatic Squamous Non-Small Cell Lung Cancer (NSCLC).
Pembrolizumab, PEMEtrexed and CARBOplatin (AUC 5) Therapy Regimen	00568a Pembrolizumab is indicated in combination with PEMEtrexed and CARBOplatin for the first-line treatment of metastatic non-squamous NSCLC in adults whose tumors have no EGFR or ALK positive mutations.
Pembrolizumab, PEMEtrexed and CISplatin Therapy Regimen	00569a Pembrolizumab is indicated in combination with PEMEtrexed and CISplatin for the first-line treatment of metastatic non-squamous NSCLC in adults whose tumors have no EGFR or ALK positive mutations.
PEMEtrexed Monotherapy Regimen	00222a Maintenance treatment of locally advanced or metastatic non-small cell lung cancer other than predominantly squamous cell histology in patients who disease has not progressed immediately following platinum-based chemotherapy. 00222b Second line treatment of patients with locally advanced or metastatic NSLC other than predominantly squamous cell histology.
Tepotinib Therapy Regimen	00823a As monotherapy for the treatment of adult patients with advanced non-small cell lung cancer (NSCLC) harbouring alterations leading to mesenchymal-epithelial transition factor gene exon 14 (METex14) skipping, who require systemic therapy following prior treatment with immunotherapy and/or platinum-based chemotherapy.
PEMEtrexed and CARBOplatin Therapy Regimen	00318a Treatment of chemotherapy naïve patients with unresectable malignant pleural mesothelioma. 00318b First line treatment of patients with locally advanced or metastatic non-small cell lung cancer (NSCLC) other than predominantly squamous cell histology. 00318c In combination with nivolumab for the neoadjuvant treatment of resectable NSCLC at high risk of recurrence in adult patients whose tumours have PD-L1 expression ≥ 1%
PEMEtrexed and CISplatin Therapy Regimen	00317a Treatment of chemotherapy naïve patients with unresectable malignant pleural mesothelioma. 00317b First line treatment of patients with locally advanced or metastatic non-small cell lung cancer (NSCLC). 00317c In combination with nivolumab for the neoadjuvant treatment of resectable NSCLC at high risk of recurrence in adult patients whose tumours have PD-L1 expression ≥ 1%
Topotecan Monotherapy-5 day Regimen	00311b Treatment of patients with relapsed small cell lung cancer (SCLC) for whom re-treatment with the first-line regimen is not considered appropriate.
Topotecan Oral Monotherapy Regimen	00587a Treatment of adult patients with relapsed small cell lung cancer (SCLC) for whom re-treatment with the first –line regimen is not considered appropriate
Oral Vinorelbine Monotherapy 7 days Regimen	00259b Non small cell lung cancer (NSLC)
Intravenous Vinorelbine Therapy-21 days Regimen	00232b Non small cell lung cancer (NSLC)
Vinorelbine and CISplatin Therapy-28 days Regimen	00343a Adjuvant treatment of patients with completely resected stage IB, ll or lllA non small cell lung cancer (NSLC). 00343b Treatment of locally advanced recurrent or metastatic NSCLC.
Vinorelbine 30 (Day 1, 8, 15) and CISplatin 80 (Day 1) Therapy-21 day Regimen	00339a Adjuvant treatment of patients with completely resected stage IB, ll or lllA non small cell lung cancer (NSLC). 00339b Treatment of locally advanced recurrent or metastatic NSCLC.

Regimen Name

Indication

Afatinib Monotherapy