Recomendaciones de oncólogos que trabajan en el ISSSTE para el tratamiento sistémico del cáncer de pulmón avanzado 2020

Based on the GRADE system, a group of specialists in Medical Oncology from ISSSTE produced a set of recommendations for the systemic treatment of advanced lung cancer —specifically non-small cell lung cancer and small-cell lung cancer— with immunotherapy, chemotherapy with or without antiangiogenic agents. Regarding the diagnosis, extension studies and lung grades are analyzed. Likewise, basic pathology, molecular biology, and imaging features are described to determine the treatment protocols for advanced lung cancer with actionable mutations or biomarkers related to domains such as actionable mutations, anaplastic lymphoma kinase, and reactive oxygen species (ROS1). The recommendations comprise the most important clinical issues: immunotherapy in lung cancer, first-line treatment for non-small cell lung cancer, non-squamous (wild-type) metastatic cancer, second-line immunotherapy regimes, chemotherapy without first-line immunotherapy for adenocarcinoma, firstline chemotherapy with antiangiogenic agents, as well as the characteristics a patient should present to be a candidate to receive immunotherapy. Dosages are stated in the different treatment protocols; the chemotherapy regimes for unresectable, locally-advanced lung cancer are being reviewed, as well as for ECOG 0-1 until ECOG 2, limited and extended stages. Even though there is no consensus on certain topics, this document includes clear guidelines whose aim is standardizing the criteria, and that will be subject to be reviewed and updated.