2
Key Points
➤ All patients with non-squamous NSCLC should have results of
testing for potentially targetable mutations (alterations) prior to
implementing therapy for advanced lung cancer, regardless of
smoking status, when possible following other existing high quality
testing guidelines.
➤ Most patients should receive targeted therapy for these alterations:
• Targeted therapies against EGFR, ALK, ROS1 fusions, BRAF (+/– V600E
mutations), MET exon 14 skipping mutations, RET-fusions, and NTRK-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 EGFR
mutations (exon 19 deletion; exon 21 L858R; exon 20 T790M).
• Alectinib or brigatinib is the optimal first-line line treatment for patients with
ALK-fusions.
➤ For the first time, this guideline includes recommendations regarding
RET, MET, and NTRK alterations.
➤ Chemotherapy is still an option at most stages.
Recommendation Grading
Type Benefit/harm Evidence Quality
Strength of
Recommendation
EB Evidence-
based
B Benefits
outweigh
harms
H High Strong
FC
Formal
consensus
H Harms
outweigh
benefits
I Intermediate Moderate
IC Informal
consensus
B/H Relative
balance of
benefits and
harms
L Low Weak
U Benefits/harms
ratio uncertain
Ins Insufficient
