Updated ASCO Guidelines for Treating Stage IV Non–Small-Cell Lung Cancer

Clinical Takeaway

: In stage IV NSCLC, biomarker testing should now drive nearly every first-line decision.

Sponsoring Organization: American Society of Clinical Oncology (ASCO)

Background

Non–small-cell lung cancer (NSCLC) comprises a multitude of biomarker-driven diseases. Two ASCO guidelines on stage IV NSCLC highlight the need for biomarker analysis in treatment decisions and show the array of treatment options.

Key Recommendations

Start with testing. At diagnosis, order a tissue or blood-based multigene panel. At minimum, look for mutations in EGFR, HER2, BRAF, KRAS; rearrangements in ALK, ROS1, RET, NTRK, NRG1; and MET exon 14 skipping. Use immunohistochemistry to check for PD-L1 and HER2.
If a driver is present, target the therapy. If testing identifies a driver alteration, targeted therapy is critical and often the preferred first-line treatme…

Reviewing Author

Rebecca S. Heist, MD, MPH

Disclosures

Consultant / Advisory BoardAmgen, Verastem, Astrazeneca, Genentech Roche, Gilead, Biohaven, Merck, Daichii Sankyo