325 Ch 324. Non-Small Cell Lung Cancer (NSCLC) — Treatment

NSCLC treatment 已從 chemotherapy 範式進入 precision medicine + immunotherapy 時代；stage-based approach：(1) early stage (I-II) = surgical resection ± neoadjuvant/adjuvant；(2) locally advanced (III) = chemoradiation + durvalumab consolidation (PACIFIC) 或 osimertinib (LAURA EGFR+)；(3) metastatic (IV) = molecular profiling-driven targeted therapy or immunotherapy (PD-L1 ≥ 50% pembrolizumab; combination chemo + IO for others)；driver mutations targets：EGFR → osimertinib (FLAURA, ADAURA)；ALK → alectinib/brigatinib/lorlatinib (ALEX, ALTA-1L, CROWN)；ROS1 → crizotinib/entrectinib/repotrectinib；KRAS G12C → sotorasib/adagrasib (CodeBreaK)；MET → capmatinib/tepotinib；HER2 → trastuzumab deruxtecan (DESTINY-Lung)；BRAF → dabrafenib + trametinib；NTRK → larotrectinib/entrectinib；RET → selpercatinib/pralsetinib；immunotherapy：pembrolizumab、nivolumab、atezolizumab、durvalumab、cemiplimab、tremelimumab；neoadjuvant immunotherapy (CheckMate 816, AEGEAN, KEYNOTE-671) 改寫 perioperative approach；TROP2 ADC (datopotamab deruxtecan) + HER3 ADC (patritumab deruxtecan) 為 2024 新興；MRD-guided adjuvant therapy 為前沿。