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Guidelines & Advice
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Therapy for Stage IV Non–Small-Cell Lung Cancer With Driver Alterations: American Society of Clinical Oncology (ASCO) and Ontario Health (Cancer Care Ontario) Joint Guideline Update

ID: 7-A-2018-3 Feb 2021
Type of Content: Guidelines & Advice, Clinical
Document Status: Current
Authors:
Nasser H. Hanna, MD, Andrew G. Robinson, MD, Sarah Temin, MSPH, Sherman Baker Jr, MD, Julie R. Brahmer, MD, Peter M. Ellis, MD, PhD, Laurie E. Gaspar, MD, MBA, Rami Y. Haddad, MD, Paul J. Hesketh, MD, Dharamvir Jain, MD, Ishmael Jaiyesimi, MD, David H. Johnson, MD, MACP, Natasha B. Leighl, MD, Pamela R. Moffitt, Tanyanika Phillips, MD, Gregory J. Riely, MD, PhD, Rafael Rosell, MD, Joan H. Schiller, MD, Bryan J. Schneider, MD, Navneet Singh, MD, DM, David R. Spigel, MD, Joan Tashbar, and Gregory Masters, MD

Guideline Objective:

This clinical practice guideline was produced jointly by the American Society of Clinical Oncology (ASCO) and Ontario Health (Cancer Care Ontario). The aim of this work is to provide evidence-based recommendations updating the 2017 ASCO guideline on systemic therapy for patients with stage IV non–small-cell lung cancer (NSCLC) with driver alterations. A guideline update for systemic therapy for patients with stage IV NSCLC without driver alterations was published separately. The joint guideline is published in the Journal of Clinical Oncology (JCO) and can be accessed directly from the link "Full Report” below. Due to rapidly evolving evidence on this topic, ASCO has updated this guidance as a Living Guideline. For updated recommendations, visit Therapy for Stage IV Non-Small Cell Lung Cancer with Driver Alterations Living Guideline. 

Patient Population:

Patients with stage IV NSCLC with driver alterations in epidermal growth factor receptor (EGFR), anaplastic lymphoma kinase (ALK), ROS-1 fusions, BRAF V600e mutations, RET fusions, MET exon 14 skipping mutations, and NTRK fusions (with known marker status test results available to the clinician). The update does not apply to patients with stage IV NSCLC without known driver alterations. The guideline also does not apply to patients with stage IV NSCLC with rarer histologies, for example, large cell, neuroendocrine, etc.

Intended Guideline Users:

Oncology care providers (including primary care physicians, specialists, nurses, social workers, and any other relevant member of a comprehensive multidisciplinary cancer care team) in North America and beyond.

Research Question(s)

This clinical practice guideline addresses three overarching clinical questions: For patients with stage IV NSCLC with driver alterations:

  1. What is the most effective first-line therapy?
  2. What is the most effective second-line therapy?
  3. Is there a role for a third-line therapy or beyond? The guideline addresses patients with NSCLC in the following histologic or subgroups: EGFR, ALK, ROS1, BRAF, MET, RET, HER2, and NTRK.
pdf download Full Report (PDF) (502.69 KB)