Indiana University Simon Comprehensive Cancer Center, Indianapolis, IN.
Kingston General Hospital, School of Medicine, Queen's University, ON, Canada.
J Clin Oncol. 2021 Mar 20;39(9):1040-1091. doi: 10.1200/JCO.20.03570. Epub 2021 Feb 16.
PURPOSE: To provide evidence-based recommendations updating the 2017 ASCO guideline on systemic therapy for patients with stage IV non-small-cell lung cancer (NSCLC) with driver alterations. A guideline update for systemic therapy for patients with stage IV NSCLC without driver alterations was published separately. METHODS: The American Society of Clinical Oncology and Ontario Health (Cancer Care Ontario) NSCLC Expert Panel updated recommendations based on a systematic review of randomized controlled trials (RCTs) from December 2015 to January 2020 and meeting abstracts from ASCO 2020. RESULTS: This guideline update reflects changes in evidence since the previous update. Twenty-seven RCTs, 26 observational studies, and one meta-analysis provide the evidence base (total 54). Outcomes of interest included efficacy and safety. Additional literature suggested by the Expert Panel is discussed. RECOMMENDATIONS: All patients with nonsquamous NSCLC should have the results of testing for potentially targetable mutations (alterations) before implementing therapy for advanced lung cancer, regardless of smoking status recommendations, when possible, following other existing high-quality testing guidelines. Most patients should receive targeted therapy for these alterations: Targeted therapies against -1 fusions, V600e mutations, fusions, exon 14 skipping mutations, and fusions should be offered to patients, either as initial or second-line therapy when not given in the first-line setting. New or revised recommendations include the following: 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. For the first time, to our knowledge, the guideline includes recommendations regarding alterations. Chemotherapy is still an option at most stages.Additional information is available at www.asco.org/thoracic-cancer-guidelines.
目的：提供循证推荐更新 2017 年 ASCO 关于有驱动基因突变的 IV 期非小细胞肺癌（NSCLC）患者系统治疗指南。另一份关于无驱动基因突变的 IV 期 NSCLC 患者系统治疗的指南更新已单独发布。
方法：美国临床肿瘤学会（ASCO）和安大略省卫生厅（安大略省癌症护理） NSCLC 专家组根据 2015 年 12 月至 2020 年 1 月的随机对照试验（RCT）系统评价和 ASCO 2020 年会摘要的更新建议进行了更新。
结果：本指南更新反映了自上次更新以来证据的变化。27 项 RCT、26 项观察性研究和 1 项荟萃分析提供了证据基础（共计 54 项）。感兴趣的结果包括疗效和安全性。专家组建议讨论其他文献。
建议：无论吸烟状况如何，建议在实施晚期肺癌治疗之前，所有非鳞状 NSCLC 患者都应在可能的情况下根据其他现有高质量检测指南进行潜在靶向突变（改变）的检测结果。大多数患者应接受针对这些改变的靶向治疗：对于 -1 融合、V600e 突变、融合、外显子 14 跳跃突变和融合，应将靶向治疗作为一线或二线治疗提供给患者，除非在一线治疗中未使用。新的或修订的建议包括以下内容：奥希替尼是有激活表皮生长因子受体突变（外显子 19 缺失、外显子 21 L858R 和外显子 20 T790M）患者的最佳一线治疗药物；阿来替尼或布加替尼是有间变性淋巴瘤激酶融合的患者的最佳一线治疗药物。据我们所知，该指南首次包括关于 改变的建议。在大多数情况下，化疗仍然是一种选择。更多信息可在 www.asco.org/thoracic-cancer-guidelines 上获取。
Pharmacol Res Perspect. 2025-6
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