The American Society of Clinical Oncology (ASCO) released an update to their Stage IV Non-Small Cell Lung Cancer With/Without Driver Alterations guidelines. These updates follow the 2022 publication of the previous versions of these guidelines, which have since been updated based on literature searches conducted through March 10, 2025. 

Both guidelines received two updates based on the literature search. For your convenience, we outlined them all below along with accompanying summaries and full-text versions.

Key Elements of the 2025 Update:


Therapy for Stage IV Non-Small Cell Lung Cancer WITHOUT Driver Alterations
Summary | Full Text

  • Guideline Updates:
    • First-Line Treatment Options for Patients With Good Performance Status, Any Histology, and Any PD-L1 Expression: Clinicians may offer nivolumab and ipilimumab plus two cycles of platinum-based chemotherapy (Evidence quality: Moderate; Strength of recommendation: Weak).
    • Second-Line and Subsequent Treatment Options for Patients With Good PS: Clinicians should offer docetaxel with or without ramucirumab if the patient has already received platinum-based chemotherapy (Evidence quality: Low; Strength of recommendation: Strong).

Therapy for Stage IV Non-Small Cell Lung Cancer WITH Driver Alterations
Summary | Full Text

  • Guideline Updates:
    • EGFR Exon 19 Deletion, Exon 21 L858R Substitution, First-Line Treatment Options Update: Clinicians may offer osimertinib with platinum doublet chemotherapy or amivantamab plus lazertinib (Evidence quality: Moderate; Strength of recommendation: Weak).
    • NRG1 Fusion, Second-Line Treatment Options Update: Clinicians may offer zenocutuzumab (Evidence quality: Low; Strength of recommendation: Strong).

Check out our free pocket guides to quickly catch up on these recently updated guidelines along with the other, unchanged recommendations:

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