In February 2021, the American Society of Clinical Oncology (ASCO) and Ontario Health (Cancer Care Ontario) published a joint guideline update to the 2017 ASCO guidelines regarding systemic therapy for stage IV NSCLC. This update focused on therapy for patients with stage IV NSCLC with driver alterations, and it discussed treatment options for ROS1 fusions (entrectinib), BRAF V600e mutations (dabrafenib/trametinib), RET fusions (pralsetinib or selpercatinib), MET exon 14–skipping mutations (capmatinib or tepotinib), and NTRK fusions (entrectinib or larotrectinib). Key updates also included recommending osimertinib as the optimal first-line treatment for patients with activating EGFR mutations (exon 19 deletion, exon 21 L858R, and exon 20 T790M) and alectinib or brigatinib as the optimal first-line treatment for patients with ALK alterations.
Another notable aspect of this update is that it was an international consensus, recommended both by ASCO and Ontario Health (Cancer Care Ontario). It is also the first one to be devoted to stage IV NSCLC with driver alterations; the 2017 update involved recommendations for patients with stage IV disease both with and without driver mutations and involved chemotherapy, immunotherapy, and targeted therapy. In 2017, only afatinib, erlotinib, or gefitinib were recommended for first-line therapy for EGFR-sensitizing mutations, and crizotinib was recommended for first-line treatment of ALK and ROS1 gene rearrangements. The 2021 guidelines have updated these recommendations, and they include five new driver mutations that have been identified since the previous guideline that now have targetable drugs.
- 1. 1. Hanna NH, Robinson AG, Temin S, et al. Therapy for stage IV non-small cell lung cancer with driver alterations: ASCO and OH (CCO) joint guideline update. J Clin Oncol. 2021 Feb 16. [Epub ahead of print].
- 2. 2. Hanna N, Johnson D, Temin S, et al. Systemic Therapy for Stage IV Non-Small-Cell Lung Cancer: American Society of Clinical Oncology Clinical Practice Guideline Update. J Clin Oncol . 2017;35(30):3484-3515.