Select first-line treatment based on PD-L1 + gBRCA + prior therapy
PD-L1 CPS ≥10 — regardless of gBRCA status*
*If PD-(L)1 inhibitor therapy is contraindicated/not appropriate, use an eligible non-immunotherapy first-line regimen.
SG + pembrolizumab OR pembrolizumab + chemotherapy
Is Disease Progressing Or Treatment Intolerable At 6–12-Week Assessment?
Continue Current Therapy Until Progression, Unacceptable Toxicity, Or Planned Pembrolizumab Completion
Use Remaining Eligible ADC, Matched Therapy, Non-Cross-Resistant Chemotherapy, Or Clinical Trial
PD-L1 CPS <10 + gBRCA1/2 PV
Olaparib or Talazoparib, or Platinum Chemotherapy
Is Disease Progressing Or Treatment Intolerable At 6–12-Week Assessment?
Continue Current Therapy Until Progression, Unacceptable Toxicity, Or Planned Pembrolizumab Completion
Use Remaining Eligible ADC, Matched Therapy, Non-Cross-Resistant Chemotherapy, Or Clinical Trial
PD-L1 CPS <10 + No gBRCA1/2 PV
Preferred: Sacituzumab Govitecan or Dato-DXd; Other: Systemic Chemotherapy
My description...
Is Disease Progressing Or Treatment Intolerable At 6–12-Week Assessment?
Continue Current Therapy Until Progression, Unacceptable Toxicity, Or Planned Pembrolizumab Completion
Use Remaining Eligible ADC, Matched Therapy, Non-Cross-Resistant Chemotherapy, Or Clinical Trial
Safety Callouts
Screen Carefully Before Pembrolizumab Stop Pembrolizumab After Planned Maximum Duration Adjust PARP Inhibitors For Renal Function Interrupt T-DXd Immediately For Suspected ILD Prevent Sacituzumab Neutropenia And Diarrhea