FDA-Approved Non-Small Cell Lung Cancer (NSCLC) Treatments
| FDA-APPROVED NON-SMALL CELL LUNG CANCER (NSCLC) TREATMENTS | ||||
|---|---|---|---|---|
| Generic | Brand | Strength | Form | Adult Dose |
| Angiogenesis inhibitor | ||||
| bevaci– zumab |
Avastin | 100mg, 400mg |
soln for IV infusion after dilution |
15mg/kg once every 3wks with carboplatin/paclitaxel |
| bevacizumab-awwb | Mvasi | 100mg, 400mg | soln for IV infusion after dilution | 15mg/kg every 3wks with carboplatin/paclitaxel until disease progression or unacceptable toxicity |
| bevacizumab-bvzr | Zirabev | 100mg, 400mg | soln for IV infusion after dilution | 15mg/kg every 3wks with carboplatin/paclitaxel |
| ramuci– rumab |
Cyramza | 10mg/mL | soln for IV infusion after dilution |
Exon 19 deletions or exon 21 mutations: 10mg/kg every 2wks with erlotinib. Disease progression: 10mg/kg on Day 1 of a 21-day cycle prior to docetaxel. Both: continue until disease progression or unacceptable toxicity. |
| Antimetabolites | ||||
| gemcitabine | Gemzar | 200mg, 1g | pwd for IV infusion after reconstitution |
Give with cisplatin 100mg/m² administered on Day 1 after gemcitabine. 1000mg/m² on Days 1, 8, and 15 of each 28-day cycle; or 1250mg/m² on Days 1 and 8 of each 21-day cycle |
| Infugem | 1200mg/120mL, 1300mg/130mL, 1400mg/140mL, 1500mg/150mL, 1600mg/160mL, 1700mg/170mL, 1800mg/180mL, 1900mg/190mL, 2000mg/200mL, 2200mg/220mL | soln for IV infusion | ||
| metho– trexate |
— | 25mg/mL | soln for IV,
IM, intra- arterial, or intrathecal administration after dilution |
See drug monograph and manufacturer’s full labeling |
| 1g | pwd for
IV, IM, intra- arterial, or intrathecal administration after dilution |
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| Trexall | 5mg, 7.5mg, 10mg, 15mg | scored tabs | ||
| pemetrexed | Alimta | 100mg, 500mg | pwd for IV infusion after reconstitution and dilution |
CrCl ≥45mL/min: 500mg/m² on Day 1 of each 21-day cycle. In combination with pembrolizumab and platinum chemotherapy: treat for 4 cycles; following platinum-based therapy completion, give pemetrexed with or without pembrolizumab until disease progression or unacceptable toxicity. In combination with cisplatin: treat for up to 6 cycles in the absence of disease progression or unacceptable toxicity. Maintenance, recurrent NSCLC: continue until disease progression or unacceptable toxicity. Supplement with oral folic acid and IM vitamin B12 one week prior to 1st pemetrexed dose, during treatment, and for 21 days after last dose. Pretreat with dexamethasone for 3 consecutive days, beginning the day before each pemetrexed dose. |
| Antimicrotubule agents | ||||
| docetaxel | Taxotere | 20mg/mL | soln for IV infusion after dilution |
Infuse over 1hr once every 3wks. After platinum therapy failure: 75mg/m². Chemotherapy-naive: 75mg/m² followed by cisplatin (see full labeling). |
| paclitaxel | — | 6mg/mL | soln for IV infusion after dilution |
135mg/m² IV plus cisplatin every 3wks |
| paclitaxel [bound to albumin (human)] |
Abraxane | 100mg/ vial |
pwd for IV infusion after reconstitution |
100mg/m² on Days 1, 8, and 15 of each 21-day cycle with carboplatin |
| vinorelbine | — | 10mg/mL | soln for IV inj after dilution |
Monotherapy: 30mg/m² once weekly. Combination therapy: 25mg/m² on Days 1, 8, 15, and 22 of a 28-day cycle with cisplatin (100mg/m²) given on Day 1 of each 28-day cycle; or 30mg/m² once weekly with cisplatin (120mg/m²) given on Days 1 and 29, then every 6wks. |
| CTLA-4 Blocking Antibody | ||||
| ipilimumab | Yervoy | 5mg/mL | soln for IV infusion | Metastatic NSCLC with PD-L1: 1mg/kg every 6wks with nivolumab 3mg/kg every 2wks. Metastatic or recurrent NSCLC: 1mg/kg every 6wks with nivolumab 360mg every 3wks and histology-based platinum doublet chemotherapy every 3wks for 2 cycles. Continue with nivolumab until disease progression, unacceptable toxicity, or up to 2yrs in patients without disease progression. |
| HUMAN EGFR INHIBITOR | ||||
| necitumumab | Portrazza | 800mg/50mL | soln for IV infusion after dilution | 800mg on Days 1 and 8 of each 21-day cycle; continue until disease progression or unacceptable toxicity |
| Kinase Inhibitors | ||||
| afatinib | Gilotrif | 20mg, 30mg, 40mg | tabs | 40mg once daily on empty stomach; continue until disease progression or unacceptable toxicity |
| alectinib | Alecensa1 | 150mg | caps | 600mg twice daily until disease progression or unacceptable toxicity |
| brigatinib | Alunbrig1 | 30mg, 90mg, 180mg | tabs | 90mg once daily for first 7 days, then increase to 180mg once daily; continue until disease progression or unacceptable toxicity. |
| capmatinib | Tabrecta6 | 150mg, 200mg | tabs | 400mg twice daily. |
| ceritinib | Zykadia1 | 150mg | hard gel caps, tabs | 450mg once daily with food until disease progression or unacceptable toxicity; discontinue if 150mg once daily with food not tolerated |
| crizotinib | Xalkori1,5 | 200mg, 250mg | caps | 250mg twice daily until disease progression or unacceptable toxicity |
| dabrafenib | Tafinlar4 | 50mg, 75mg | caps | In combination with trametinib: 150mg twice daily (approx. 12hrs apart); continue until disease recurrence or unacceptable toxicity |
| dacomitinib | Vizimpro2 | 15mg, 30mg, 45mg | tabs | 45mg once daily until disease progression or unacceptable toxicity |
| erlotinib | Tarceva2 | 25mg, 100mg, 150mg | tabs | 150mg once daily until disease progression or unacceptable toxicity |
| gefitinib | Iressa2 | 250mg | tabs | 250mg once daily until disease progression or unacceptable toxicity |
| lorlatinib | Lorbrena1 | 25mg, 100mg | tabs | 100mg once daily until disease progression or unacceptable toxicity |
| osimertinib | Tagrisso2,3 | 40mg, 80mg | tabs | 80mg once daily until disease progression or unacceptable toxicity |
| pralsetinib | Gavreto7 | 100mg | caps | 400mg once daily until disease progression or until unacceptable toxicity |
| selpercatinib | Retevmo7 | 40mg, 80mg | hard gel caps | <50kg: 120mg twice daily (approx. every 12hrs). ≥50kg: 160mg twice daily (approx. every 12hrs). Continue until disease progression or unacceptable toxicity. |
| trametinib | Mekinist4 | 0.5mg, 2mg | tabs | In combination with dabrafenib: 2mg once daily (approx. 24hrs apart); continue until disease recurrence or unacceptable toxicity |
| PD-1/PD-L1 Blocking Antibodies | ||||
| atezolizumab | Tecentriq | 60mg/mL | soln for IV infusion after dilution |
Single agent: 840mg every 2wks, or 1200mg every 3wks, or 1680mg every 4wks. In combination with platinum-based chemotherapy: 1200mg every 3wks; after 4–6 cycles of chemotherapy completed, and if bevacizumab discontinued, give 840mg every 2wks, or 1200mg every 3wks, or 1680mg every 4wks. Continue until disease progression or unacceptable toxicity. In combination therapy: administer atezolizumab prior to chemotherapy and bevacizumab when given on the same day (see full labeling). |
| durvalumab | Imfinzi | 50mg/mL | soln for IV infusion after dilution |
10mg/kg every 2wks until disease progression, unacceptable toxicity, or max 12mos |
| nivolumab | Opdivo | 10mg/mL | soln for IV infusion after dilution |
NSCLC with PD-L1: 3mg/kg every 2wks with ipilimumab (1mg/kg every 6wks); continue with ipilimumab until disease progression, unacceptable toxicity, or up to 2yrs in patients without disease progression. Metastatic or recurrent NSCLC: 360mg every 3wks with ipilimumab (1mg/kg every 6wks) and histology-based platinum doublet chemotherapy every 3wks (for 2 cycles only); continue with ipilimumab until disease progression, unacceptable toxicity, or up to 2yrs in patients without disease progression. NSCLC (single-agent): 240mg every 2wks or 480mg every 4wks until disease progression or unacceptable toxicity. Combination therapy: administer Opdivo first followed by ipilimumab, and/or platinum doublet chemotherapy on the same day. |
| pembrolizumab | Keytruda | 25mg/mL | soln for IV infusion after dilution |
200mg every 3wks or 400mg every 6wks until disease progression, unacceptable toxicity, or up to 24 months in patients without disease progression. In combination with chemotherapy: give prior to chemotherapy when given on the same day (see full labeling). |
| Photosensitizing agent | ||||
| porfimer | Photofrin | 75mg | pwd for IV inj after reconstitution |
2mg/kg then illumination with laser light 40−50hrs following injection |
| NOTES | ||||
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1 For ALK-positive metastatic NSCLC only. 2 For metastatic NSCLC with EGFR exon 19 deletions or exon 21 (L858R) substitution mutations only. 3 For metastatic NSCLC with EGFR T790M mutation only. 4 For metastatic NSCLC with BRAF V600E mutation only. 5 For ROS1-positive metastatic NSCLC only. 6 For metastatic NSCLC with mutation that leads to MET exon 14 skipping only. 7 For RET fusion-positive metastatic NSCLC only. Not an inclusive list of medications, official indications, and/or dosing details. Please see drug monograph at www.eMPR.com and/or contact company for full drug labeling. (Rev. 11/2020) |
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