Therapy for Stage IV Non-Small Cell Lung Cancer without Driver Alterations Living Guideline

Living guidelines are routinely updated guidelines that are developed for selected topic areas with rapidly evolving evidence that drives frequent change in clinical practice. These guidelines are updated on a regular schedule, based on the work of a standing panel that reviews the literature on a continuous basis. 

Ishmael A. Jaiyesimi, MD, MS, Natasha B. Leighl, MD, Nofisat Ismaila, MD, Krishna Alluri, MD, Narjust Florez, MD, Shirish Gadgeel, MD, Gregory Masters, MD, Erin L. Schenk, MD, PhD, Bryan J. Schneider, MD, Lecia Sequist, MD, Navneet Singh, MD, DM, Lyudmila Bazhenova, MD, Elizabeth Blanchard, MD, Janet Freeman-Daily, MS, Engr, Naoki Furuya, MD, PhD, Balazs Halmos, MD, Ibrahim Hanna Azar, MD, Sara Kuruvilla, MD, Michael Mullane, MD, Jarushka Naidoo, MD, Joshua E. Reuss, MD, David R. Spigel, MD, Dwight H. Owen, MD, MS, and Jyoti D. Patel, MD

Nonsubstantive update

Published online, November 12, 2024

After careful review of the additional studies identified by the expert panel in the literature search dated Juy 8, 2024, it was determined that the study results do not warrant an update to the recommendations.

Abstract, Version 2023.3

Published online, February 28, 2024, DOI: 10.1200/JCO.23.02746

Purpose

To provide evidence-based recommendations for patients with stage IV non–small cell lung cancer (NSCLC) without driver alterations.

Methods

This ASCO living guideline offers continually updated recommendations based on an ongoing systematic review of randomized clinical trials (RCTs), with the latest time frame spanning February to October 2023. An Expert Panel of medical oncology, pulmonary, community oncology, research methodology, and advocacy experts were convened. The literature search included systematic reviews, meta-analyses, and randomized controlled trials. Outcomes of interest include efficacy and safety. Expert Panel members used available evidence and informal consensus to develop evidence-based guideline recommendations.

Results

This guideline consolidates all previous updates and reflects the body of evidence informing this guideline topic. Ten new RCTs were identified in the latest search of the literature to date.

Recommendations

Evidence-based recommendations were updated to address first, second, and subsequent treatment options for patients without driver alterations.

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Guideline Disclaimer

The Clinical Practice Guidelines and other guidance published herein are provided by the American Society of Clinical Oncology, Inc. (ASCO) to assist providers in clinical decision making. The information herein should not be relied upon as being complete or accurate, nor should it be considered as inclusive of all proper treatments or methods of care or as a statement of the standard of care. With the rapid development of scientific knowledge, new evidence may emerge between the time information is developed and when it is published or read. The information is not continually updated and may not reflect the most recent evidence. The information addresses only the topics specifically identified therein and is not applicable to other interventions, diseases, or stages of diseases. This information does not mandate any particular course of medical care. Further, the information is not intended to substitute for the independent professional judgment of the treating provider, as the information does not account for individual variation among patients. Recommendations specify the level of confidence that the recommendation reflects the net effect of a given course of action. The use of words like “must,” “must not,” “should,” and “should not” indicates that a course of action is recommended or not recommended for either most or many patients, but there is latitude for the treating physician to select other courses of action in individual cases. In all cases, the selected course of action should be considered by the treating provider in the context of treating the individual patient. Use of the information is voluntary. ASCO does not endorse third party drugs, devices, services, or therapies used to diagnose, treat, monitor, manage, or alleviate health conditions. Any use of a brand or trade name is for identification purposes only.  ASCO provides this information on an “as is” basis and makes no warranty, express or implied, regarding the information. ASCO specifically disclaims any warranties of merchantability or fitness for a particular use or purpose. ASCO assumes no responsibility for any injury or damage to persons or property arising out of or related to any use of this information, or for any errors or omissions.