Study aid only. Verify against current guidelines, primary literature, staging manuals, and prescribing information before clinical use.

← All algorithms  ·  Related notes →

Metastatic NSCLC — No Targetable Driver, First-Line

First-line Second-line Later-line SECOND-LINE THIRD-LINE / LATER Metastatic NSCLC no targetable driver PD-L1 tested PD-L1 ≥ 50% PD-L1 1–49% / nonsquamous Squamous PD-L1 < 1% Second-line Third-line + Low burden Pembrolizumab monotherapy KEYNOTE-024 / 042 ↗ High burden Chemo + pembrolizumab KEYNOTE-189 ↗ Combo Carbo / pemetrexed + pembro KEYNOTE-189 ↗ Combo Carbo / taxane + pembro KEYNOTE-407 ↗ Dual-IO Nivo + ipi + 2 cycles chemo CheckMate 9LA ↗ Antiangiogenic Docetaxel + ramucirumab REVEL ↗ Cytotoxic Docetaxel single agent if ramucirumab unavailable Cytotoxic Single-agent chemo not used pemetrexed / gemcitabine Always Clinical trial / supportive care performance-status based