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
...Treatment...
...unless otherwise listed, recommendatio...
...EGFR First-...
...1.1For patients with a sensitizing (L858R/exon 1...
...tion 1.2For patients with a sensitizi...
...on 1.3For patients with a sensitizing...
...ation 1.4For patients with a sensitizin...
...ecommendation 1.5For patients with a sensitiz...
...ion 1.6For patients with a sensitiz...
Recommendation 1.7
...b monotherapy ( IC , , L ,...
...r osimertinib ( IC , , L ,...
...r standard treatment based on the ASCO/OH...
...ecommendation 1.8For patients with any...
...dation 1.9For patients with an exon 20 insertion...
...EGFR Second-line...
...ommendation 2.1For patients with a se...
....2For patients with any EGFR mutation whos...
...mmendation 2.3New: For patients with advanced...
...ecommendation 2.4New: For patients with advanced N...
...ALK First-...
...mendation 3.1...
...ib or brigatinib ( EB , B , H , S )6...
or lorlatinib. ( EB , B ,...
...endation 3.2For patients with an ALK rearrangement...
...ALK Second-...
...on 4.1For patients with an ALK rearrangemen...
...n 4.2For patients with an ALK rearrangement, a...
...ommendation 4...
...( IC , , L , M )618...
...r clinicians may offer standard therapy b...
...ROS1 Fi...
...ndation 5.1For patients with ROS1 rearrang...
...ecommendation 5.2For patients with ROS1 rearra...
...mendation 5.3For patients with ROS1 rearrange...
...ROS1 Seco...
...mendation 6.1For patients with ROS1...
...dation 6.2For patients with ROS1 rearrangement,...
...BRAF Fir...
...tion 7.1For patients with a BRAF V600E mutation...
...7.2For patients with a BRAF V600E mut...
...BRAF Se...
...ndation 8.1For patients with a BRAF V600E mutation...
...ecommendation 8....
...metinib ( IC , , L , M )618...
or dabrafenib alone ( IC , , L , W )6...
or vemurafenib ( IC , B ,...
Recommendation 8.3For patients wit...
...on 8.4For patients with BRAF mutation...
...MET First-line...
...mmendation 9.1For patients with a MET exo...
...9.2For patients with a MET exon 14 sk...
...MET Second-line...
...10.1Patients with MET abnormalities other than ex...
...ation 10.2For patients with a MET exo...
...RET Rearrangement F...
...ation 11.1For patients with a RET rearr...
...ion 11.2For patients with a RET rearra...
...RET Rearrangement Seco...
...ecommendation 12.1For patients wit...
...endation 12.2...
...atinib ( IC , , L , M )618...
...pralestinib. ( IC , , L , W )6...
...NTRK First-line...
...13.1For patients with an NTRK fusion, a...
Recommendation 13.2For patients with an N...
NTRK Secon...
...tion 14.1For patients with an NTRK fusi...
...ecommendation 14.2For patients with an NT...
...New Recomme...
...ndation 15.1(Updated) For patients wit...
...commendation 16.1(Updated) For patients with...
...New Re...
...dation 16.2New: For patients with advanc...
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