​“美国非小细胞肺癌NCCN指南，该指南旨在给患者提供治疗信息，帮助患者从“0”到“1”认识肺癌，找到适合的治疗方案。本指南有些建议也许不适合你，你的医生可能会根据你的情况和其他因素制定不一样的治疗方案。”

本公众号将非小细胞肺癌NCCN指南重新整理拆分，将以中英文在公众号连载的方式发布，本指南不能做任何商业用途，转载请联系本公众号。

译者：朱志华、梅伟健

Part7.3 ROS1基因重排

指南23列出了RSSl基因重组的治疗方案。这些选项可能会帮助你，不管你的表现状态如何。

Guide 23 lists treatment options for ROS1 gene rearrangements. These options may help you no matter your performance status.

1、一线治疗

你可以有两个选择。NCCN专家的首选方案是crizotinib。另一种选择是ceritinib。这些治疗都是有针对性的治疗。

You may have two options. The preferred option of NCCN experts is crizotinib. The other option is ceritinib. These treatments are targeted therapies.

2、二线治疗

在你做一线治疗时癌症可能恶化。如果癌症没有恶化，可以选择坚持一线治疗。可以添加局部治疗。它有时被用于可控制区域的转移。这些区域包括大脑或肾上腺。

如果需要转换方案治疗，在使用克唑替尼之后，你还可以选择色瑞替尼、阿雷替尼或brigatinib。在这种情况下，也可以增加局部治疗。

以铂为基础的化疗可能是另一个选择。如果有多种转移性肿瘤引起症状，则经常使用。阅读指导26学习腺癌，大细胞，和未知的类型的更多的选择，阅读《指南》27，了解鳞状细胞癌的更多选择。

The cancer may worsen while on first-line treatment. If the cancer doesn’t worsen much, one option may be to stay on first-line treatment. Local treatment may be added. It is sometimes used when the metastasis is within a confined area. Examples of these areas are the brain or adrenal gland.

Platinum-based chemotherapy may be an option. It is often used if there are multiple metastatic tumors causing symptoms. Read Guide 26 to learn more options for Adenocarcinoma, large cell, and unknown types. Read Guide 27 to learn more options for Squamous cell carcinoma.

Part7.4 BRAF V600E突变

指南24列出了，RAH V600E突变的治疗方案。使用曲美替尼是一种选择。如果这些治疗方法让你病得很重，你可能会独自接受达拉非尼或维罗非尼治疗。另一种选择是以铂类为基础的化疗。然而，需要更多的研究来了解这些治疗的效果。

Guide 24 lists treatment options for BRAF V600E mutation. Dabrafenib with trametinib is one option. If these treatments make you too sick, you may receive dabrafenib or vemurafenib alone. Another option is platinum-based chemotherapy. However, more research is needed to learn how well these treatments work.

Part7.5 PD-L1 阳性

指南25列出了PD-L1阳性≥506的治疗方案。派姆单抗是一线治疗的一种选择。如果你不能服用派姆单抗，基于铂的化疗可能是一种选择。

Guide 25 lists treatment options for cancers PD-L1 positive ≥50%. Pembrolizumab is an option for firstline treatment. Platinum-based chemotherapy may be an option if you can’t take pembrolizumab.

使用派姆单抗期间癌症可能恶化。在这种情况下，基于铂的化疗可能是一种选择。阅读指导26学习腺癌，大细胞，和未知的类型的更多的选择。阅读《指南》27，了解鳞状细胞癌的更多选择。

The cancer may worsen while taking pembrolizumab. In this case, platinum-based chemotherapy may be an option. Read Guide 26 to learn more options for Adenocarcinoma, large cell, and unknown types. Read Guide 27 to learn more options for Squamous cell carcinoma.

Part7.6 暂未发现分子标志物

T本节列出了生物标志物未知时的治疗方法。这些治疗方法也可用于一线治疗已知生物标志物的转移性肺癌的后续治疗。

This section lists treatments for when biomarkers are absent or unknown. These treatments may also be used as after first-line treatment for metastatic lung cancers with known biomarkers.

1、腺癌、大细胞癌和未知类型

指南26列表为腺癌，大细胞癌，和未知的类型提供了治疗方案。方案选择取决于身体功能状态。

Guide 26 lists treatment options for adenocarcinomas, large cell carcinomas, and unknown types. Treatment options are based on performance status.

2、一线治疗

如果你的功能评分是0到2你会接受化疗。你的医生将根据它能如何有效地阻止癌症的生长，而不是它的危害程度来为你会选择一种方案。两种药物的使用被称为双重化疗。这是一个选择，如果你的功能评分是0或 1。另一种选择是贝伐单抗联合化疗。要接受这种治疗，你不能有咳血的病史。第三种选择是pembrolizumab和化疗。

You may be treated with chemotherapy if your performance score is between 0 and 2. Your doctor will choose a regimen based on how well it will stop cancer growth compared to how harmful it could be. The use of two drugs is called doublet chemotherapy. It is an option if your performance score is 0 or 1. Another option is bevacizumab used with chemotherapy. To receive this treatment, you should not have a recent history of coughing up blood (hemoptysis). A third option is pembrolizumab and chemotherapy.

经过2个周期的化疗，癌症对治疗的反应将会得到评估。每2到4次循环【评估一次。如果没有肿瘤生长，建议进行4 - 6个化疗周期。如果你的功能评分时3或4分，化疗也将是有害的。因此，建议最好进行支持性护理。支持性护理的目的是治疗癌症引起的症状。

After 2 cycles of chemotherapy, the cancer’s response to treatment will be tested. It will be tested again every 2 to 4 cycles. If there’s no cancer growth, a total of 4 to 6 chemotherapy cycles are advised.

A performance score of 3 or 4 suggests that chemotherapy will be too harmful. Therefore, the best supportive care is advised. Supportive care aims to treat the symptoms caused by the cancer.

3、维持治疗

一线治疗可可能以阻止癌症恶化。在这种情况下，你可以维持一线治疗。这叫做持续性维持治疗。另一种选择是把你没有服用过的药物当成一线治疗。这叫做转换性维持治疗。第三个选项是开始频繁随访观察。观察是观察癌症状态变化的一段时期。

First-line treatment may stop the cancer from getting worse. In this case, you may stay on some of your first-line treatments. This is called continuation maintenance. Another option is changing to a medicine that you didn’t take as a first-line treatment. This is called switch maintenance. A third option is to start close observation. Observation is a period of testing to watch changes in cancer status.

4、二线治疗

在你使用一线治疗期间癌症可能恶化。下一步治疗取决于你的功能评分。参加临床试验一直是肺癌治疗的一个选择。询问你的治疗团队是否有可以加入的临床试验。也要了解一下试验的利弊。

The cancer may worsen during or after first-line treatment. Treatment is based on performance status. Joining a clinical trial is always an option for lung cancer treatment. Ask your treatment team if there is a clinical trial you can join. Also ask about the pros and cons of the trial.

5、功能评分0 - 2

对这些分数的患者，纳武单抗，派姆单抗，阿特珠单抗是NCCN专家推荐的首选。派姆单抗被批准用于pd - l1阳性的肺癌。其他选择包括化疗方案。不要服用你之前用过的化疗药物。

For these scores, nivolumab, pembrolizumab, and atezolizumab are preferred by NCCN experts. Pembrolizumab is approved for lung cancers that are PD-L1 positive. Other options include regimens with chemotherapy. Do not take the chemotherapy drugs listed if you’ve had them before.

6、功能评分3 - 4

对于这些分数的患者，大多数抗癌药物可能会严重损害你的健康。因此，建议选择支持性护理。

If these scores, most cancer drugs are likely to seriously harm your health. Thus, best supportive care is advised.

鳞状细胞癌

指南27列出了鳞状细胞癌的治疗方法。治疗方案取决于功能评分。

Guide 27 lists treatments for squamous cell carcinoma. Treatment options are based on performance status.

1、一线治疗

如果你的功能评分是0到2你会接受化疗。你的医生将根据它能如何有效地阻止癌症的生长，而不是它的危害程度来为你会选择一种方案。

You may be treated with chemotherapy if your performance score is between 0 and 2. Your doctor will choose a regimen based on how well it will stop cancer growth compared to how harmful it could be.

如果你的功能评分时3或4分，化疗也将是有害的。因此，建议最好进行支持性护理。支持性护理的目的是治疗癌症引起的症状。

A performance score of 3 or 4 suggests that chemotherapy will be too harmful. Therefore, the best supportive care is advised. Supportive care aims to treat the symptoms caused by the cancer.

2、维持治疗

一线治疗可可能以阻止癌症恶化。在这种情况下，你可以维持一线治疗。这叫做持续性维持治疗。另一种选择是把你没有服用过的药物当成一线治疗。这叫做转换性维持治疗。第三个选项是开始频繁随访观察。观察是观察癌症状态变化的一段时期。

First-line treatment may stop the cancer from getting worse. In this case, you may stay on some of your first-line treatments. This is called continuation maintenance. Another option is changing to a medicine that you didn’t take as a first-line treatment. This is called switch maintenance. A third option is to start close observation. Observation is a period of testing to watch changes in cancer status.

3、二线治疗

在你使用一线治疗期间癌症可能恶化。下一步治疗取决于你的功能评分。参加临床试验一直是肺癌治疗的一个选择。询问你的治疗团队是否有可以加入的临床试验。也要了解一下试验的利弊。

The cancer may worsen during or after first-line treatment. Treatment is based on performance status. Joining a clinical trial is always an option for lung cancer treatment. Ask your treatment team if there is a clinical trial you can join. Also ask about the pros and cons of the trial.

4、功能评分0 - 2

对这些分数的患者，nivolumab,pembrolizumab,atezolizumab是NCCN专家推荐的首选。Pembrolizumab被批准用于pd-l1阳性的肺癌。其他选择包括化疗方案。不要服用你之前用过的化疗药物。

Nivolumab, pembrolizumab, and atezolizumab are preferred by NCCN experts over other options. Pembrolizumab is approved for lung cancers that are PD-L1 positive. Other options include regimens with chemotherapy. Do not take the chemotherapy drugs listed if you’ve had them before.

5、功能评分3 - 4

对于这些分数的患者,大多数抗癌药物可能会严重损害你的健康。因此，建议选择支持性护理。

If your performance score is 3 or 4, most drugs for lung cancer are likely to seriously harm your health. Thus, best supportive care is advised.

综述

➢四期癌症，支持性护理可能会增强和延长寿命。向你的治疗小组询问一个支持性护理方案。

For stage IV cancers, supportive care may enhance and extend life. Ask your treatment team for a supportive care plan.

➢转移性癌应做突变检测。如果出现突变，则一线治疗包括靶向治疗。pembrolizumab可用于一线治 疗PD-L1阳性≥50%得肺癌。

Metastatic cancer should be tested for mutations. If a mutation is present, first-line treatment consists of targeted therapy. Firstline pembrolizumab may be used to treat lung cancers that are PD-L1 positive ≥50%.

➢如果你足够健康,没有已知突变的转移性疾病将接受化疗。贝伐单抗或pembrolizumab可用于腺癌、大细胞和未知亚型。如果癌症恶化，nivolumab、pembrolizumab和atezolizumab是 首选的治疗方案。如果你健康程度不够，支持性护理是一种选择。

If you are healthy enough, metastatic disease with no known mutations is first treated with chemotherapy. Bevacizumab or pembrolizumab may be added for adenocarcinoma, large cell, and unknown subtypes. If the cancer worsens, nivolumab, pembrolizumab, and atezolizumab are preferred treatment options. If you are unhealthy, supportive care is an option.

➢临床试验是所有转移性疾病一个选项。询问你的治疗团队是否有可以加入的临床试验。也要思考一下试验的利弊。

Clinical trials are an option for all metastatic disease. Ask your treatment team if there is a clinical trial you can join. Also ask about the pros and cons of the trial.