Therapy for Stage IV Non-Small-Cell Lung Cancer With Driver Alterations
Key Points
Key Points
- In 2022, ASCO launched living clinical practice guidelines for systemic therapy for patients with stage IV non–small-cell lung cancer (NSCLC) with1 and without driver alterations.2 Based on new evidence from routine literature searches, this version of the stage IV non–small-cell lung cancer with driver alterations living guideline reviews evidence and provides updated recommendations on new therapeutics.
- Singh N, Temin S, Baker S, Jr., et al: Therapy for Stage IV Non-Small-Cell Lung Cancer With Driver Alterations: ASCO Living Guideline. J Clin Oncol:JCO2200824, 2022
- Singh N, Temin S, Baker S, Jr., et al: Therapy for Stage IV Non-Small-Cell Lung Cancer Without Driver Alterations: ASCO Living Guideline. J Clin Oncol:JCO2200825, 2022
- All patients with non-squamous NSCLC should have results of testing for potentially targetable mutations (alterations) prior to implementing therapy for advanced lung cancer, regardless of smoking status, when possible following other existing high quality testing guidelines.
- This guideline includes recommendations regarding RET, MET, and NTRK alterations.
- Chemotherapy is still an option at most stages.
- This update (Recommendations 15.1 and 16.1) recommends the following for previously treated patients with HER2 or KRAS mutation:
- Monotherapy treatment with trastuzumab deruxtecan may be offered to patients with advanced NSCLC and an activating HER2, ERBB2 mutation who have received prior systemic therapy.
- Monotherapy treatment with sotorasib may be offered to patients with advanced NSCLC and a KRAS-G12C mutation who have received prior systemic therapy
Treatment
...nless otherwise listed, recommendatio...
...EGFR First-line...
...ion 1.1For patients with a sensitizing (L858R/...
...ation 1.2For patients with a sensitizing (L858R/...
Recommendation 1.3For patients with a s...
...1.4For patients with a sensitizing (...
...1.5For patients with a sensitizing (L858R/e...
...mmendation 1.6For patients with a sensitizing (L85...
...mendation 1.7...
...onotherapy ( IC , , L , M )618...
...rtinib ( IC , , L , W )6...
...atment based on the ASCO/OH non-driver muta...
...on 1.8For patients with any activating EGFR mu...
...ation 1.9For patients with an exon 20 in...
...ommendation 2.1For patients with a sensitiz...
...n 2.2For patients with any EGFR mutation w...
...ion 2.3New: For patients with advanced NSCLC with...
...ommendation 2.4New: For patients with...
ALK Firs...
...commendation...
...ib or brigatinib ( EB , B , H , S...
.... ( EB , B , L , W )618...
...commendation 3.2For patients with...
...ALK Se...
....1For patients with an ALK rearrangement, a perf...
...4.2For patients with an ALK rearrangement,...
...mmendation 4.3...
...atinib ( IC , , L , M )618...
...clinicians may offer standard therapy based...
...ROS...
...on 5.1For patients with ROS1 rearrangement, a...
...ommendation 5.2For patients with ROS1 rearran...
...n 5.3For patients with ROS1 rearrangement, a pe...
...ROS1 Second-line...
...dation 6.1For patients with ROS1 rearrang...
...n 6.2For patients with ROS1 rearrangement, a p...
...BRAF First-li...
Recommendation 7.1For patients with a BRAF V600E m...
...on 7.2For patients with a BRAF V600E mutati...
...BRAF Second-l...
...commendation 8.1For patients with...
...mendation 8....
...trametinib ( IC , , L , M )618...
...abrafenib alone ( IC , , L , W )...
...b ( IC , B , L , W )618...
...mendation 8.3For patients with a BRAF V600E m...
...dation 8.4For patients with BRAF mutations ot...
...mendation 9.1For patients with a MET...
...ommendation 9.2For patients with a MET exon...
...MET Se...
...ndation 10.1Patients with MET abnormalities...
...on 10.2For patients with a MET exon 14 skip...
...RET...
...ation 11.1For patients with a RET rearrange...
...mmendation 11.2For patients with a RET...
RET Re...
...ommendation 12.1For patients with RET rearrangemen...
...endation 12.2...
...ib ( IC , , L , M )618...
...pralestinib. ( IC , , L , W )618
...NTRK First-li...
...13.1For patients with an NTRK fusion,...
...ecommendation 13.2For patients with an NTRK fus...
...NTRK S...
...ommendation 14.1For patients with an NTRK fus...
...ecommendation 14.2For patients with an...
...New Recommendations...
...tion 15.1(Updated) For patients with...
...mendation 16.1(Updated) For patients wit...
...New Recommend...
...ecommendation 16.2New: For patients wi...
Summary of RecommendationsHaving trouble...
...that cancer clinical trials are vital...