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Guideline Updates

ASCO Updates Systemic Therapy Guideline for NSCLC With Driver Alterations

March 10, 2021

The American Society of Clinical Oncology (ASCO) released an update to its guideline on systemic therapy for patients with stage IV non-small cell lung cancer (NSCLC) with driver alterations.

This joint guideline update between ASCO and Ontario Health was based on a systematic review of 27 randomized controlled trials, 26 observational studies, and one meta-analysis.

The guideline recommends all patients with nonsquamous NSCLC should have the results of testing for potentially targetable mutations before implementing therapy, regardless of smoking status recommendation, when possible.

Additionally, targeted therapies against ROS-1 fusions, BRAF V600e mutations, RET fusions, MET exon 14 skipping mutations, and NTRK fusions should be offered to patients, either as first- or second-line therapy.

New or revised recommendations include:

  • Osimertinib is the optimal first-line treatment for patients with activating epidermal growth factor receptor mutations: exon 19 deletion, exon 21 L858R, and exon 20 T790M.
  • Alectinib or brigatinib is the optimal first-line treatment for patients with anaplastic lymphoma kinase fusions.

—Janelle Bradley

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