Navneet Singh1, Sarah Temin2, Sherman Baker3, Elizabeth Blanchard4, Julie R Brahmer5, Paul Celano6, Narjust Duma7, Peter M Ellis8, Ivy B Elkins9, Rami Y Haddad10, Paul J Hesketh11, Dharamvir Jain12, David H Johnson13, Natasha B Leighl14, Hirva Mamdani15, Gregory Masters16, Pamela R Moffitt17, Tanyanika Phillips18, Gregory J Riely19, Andrew G Robinson20, Rafael Rosell21, Joan H Schiller22, Bryan J Schneider23, David R Spigel24, Ishmael A Jaiyesimi25. 1. Postgraduate Institute of Medical Education and Research, Chandigarh, India. 2. American Society of Clinical Oncology, Alexandria, VA. 3. Virginia Commonwealth University, Richmond, VA. 4. Southcoast Centers for Cancer Care, New Bedford, MA. 5. Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD. 6. The Cancer Center at GBMC Towson, MD. 7. Dana-Farber Cancer Institute, Boston, MA. 8. Juravinski Cancer Centre, Hamilton, Ontario, Canada. 9. EGFR Resisters, Buffalo Grove, IL. 10. Affiliated Oncologists, LLC, Chicago Ridge, IL. 11. Lahey Hospital and Medical Center, Burlington, MA. 12. Houston Methodist Cancer Center, Houston, TX. 13. University of Texas Southwestern Medical Center, Dallas, TX. 14. Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada. 15. Karmanos Cancer Institute/Wayne State University, Detroit, MI. 16. Helen F. Graham Cancer Center and Research Institute, Newark, DE. 17. Patient Advocate, Galva, IA. 18. City of Hope, Duarte, CA. 19. Memorial Sloan Kettering Cancer Center, New York, NY. 20. Kingston General Hospital, Queen's University, Ontario, Canada. 21. Catalan Institute of Oncology, Barcelona, Catulunia, Spain. 22. Inova Schar Cancer Institute, Falls Church, VA. 23. University of Michigan Health System, Ann Arbor, MI. 24. Sarah Cannon Research Institute, Nashville, TN. 25. Beaumont Health Royal Oak and Oakland University William Beaumont School of Medicine, Royal Oak, MI.
Abstract
PURPOSE: To provide evidence-based recommendations updating the 2021 ASCO and Ontario Health (Cancer Care Ontario) guideline on systemic therapy for patients with stage IV non-small-cell lung cancer (NSCLC) with driver alterations. METHODS: ASCO updated recommendations on the basis of an ongoing systematic review of randomized control trials from 2020 to 2021. RESULTS: This guideline update reflects changes in evidence since the previous update. Two studies provide the evidence base. Outcomes of interest include efficacy and safety. RECOMMENDATIONS: For patients with an anaplastic lymphoma kinase rearrangement, a performance status (PS) of 0-2, and previously untreated NSCLC, clinicians should offer alectinib or brigatinib or lorlatinib. For patients with an anaplastic lymphoma kinase rearrangement, a PS of 0-2, and previously untreated NSCLC, if alectinib, brigatinib, or lorlatinib are not available, clinicians should offer ceritinib or crizotinib. For patients with a RET rearrangement, a PS of 0-2, and previously untreated NSCLC, clinicians may offer selpercatinib or pralsetinib. In second line, for patients with a RET rearrangement who have not received RET-targeted therapy, clinicians may offer selpercatinib or pralsetinib.Additional information is available at www.asco.org/thoracic-cancer-guidelines.
PURPOSE: To provide evidence-based recommendations updating the 2021 ASCO and Ontario Health (Cancer Care Ontario) guideline on systemic therapy for patients with stage IV non-small-cell lung cancer (NSCLC) with driver alterations. METHODS: ASCO updated recommendations on the basis of an ongoing systematic review of randomized control trials from 2020 to 2021. RESULTS: This guideline update reflects changes in evidence since the previous update. Two studies provide the evidence base. Outcomes of interest include efficacy and safety. RECOMMENDATIONS: For patients with an anaplastic lymphoma kinase rearrangement, a performance status (PS) of 0-2, and previously untreated NSCLC, clinicians should offer alectinib or brigatinib or lorlatinib. For patients with an anaplastic lymphoma kinase rearrangement, a PS of 0-2, and previously untreated NSCLC, if alectinib, brigatinib, or lorlatinib are not available, clinicians should offer ceritinib or crizotinib. For patients with a RET rearrangement, a PS of 0-2, and previously untreated NSCLC, clinicians may offer selpercatinib or pralsetinib. In second line, for patients with a RET rearrangement who have not received RET-targeted therapy, clinicians may offer selpercatinib or pralsetinib.Additional information is available at www.asco.org/thoracic-cancer-guidelines.