Langerhans cell histiocytosis (LCH): lines of therapy

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4 standard-of-care settings across 3 lines and 2 biomarker subgroups. Rows come from the cancer page's standard of care; the grid places each on its line and subgroup.

Line	All comers	FRα
Advanced, first line	1	·
Third line and beyond	·	1
Other settings	2	·

Advanced, first line

Subgroup	Setting	Approach	Products and trials	Guideline	Evidence
All comers	Multisystem LCH (first line)	Vinblastine and prednisone for 12 months (LCH-III), with response assessment at 6 weeks; LCH-IV tests further tailoring of duration and intensity.	VinblastineLCH-III	LCH-III (Blood 2013); LCH-IV protocol	81

Third line and beyond

Subgroup	Setting	Approach	Products and trials	Guideline	Evidence
FRα	Refractory risk-organ disease or reactivation	Cladribine plus cytarabine or clofarabine salvage; BRAF inhibitor (vemurafenib or dabrafenib, with trametinib) for BRAF V600E, MEK inhibitor for MAP2K1-mutant disease.	CladribineVemurafenibDabrafenib + trametinib	Donadieu 2019 (JCO); NCCN histiocytic neoplasms	92

Other settings

Subgroup	Setting	Approach	Products and trials	Guideline	Evidence
All comers	Single-system bone or skin	Biopsy or curettage with observation; intralesional steroid, topical therapy or indomethacin for symptomatic lesions; systemic therapy for multifocal bone or CNS-risk lesions.	Active surveillanceVinblastine	Histiocyte Society evaluation and treatment guidelines; NCI PDQ	80
All comers	Neurodegenerative LCH	MAPK-pathway inhibition (BRAF or MEK inhibitor) with neurological monitoring; early MRI detection in children with pituitary or craniofacial disease.	Dabrafenib + trametinibMRI		92

Lines and subgroups are parsed from the setting text of each standard-of-care row and can misclassify an unusual phrasing; the row’s own setting is always shown. Guideline chips reflect the NCCN category and ESMO-MCBS grade recorded on the cancer page, checked on its stated date. Not medical advice.