ASCO GUIDELINES Bundle

NSCLC Stage IV with Driver Alterations

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8 Treatment MET Second-line Recommendation 10.1 ➤ Patients with MET abnormalities other than exon 14 skipping mutations, a performance status of 0–2, or those previously treated with MET-targeted therapy, clinicians should offer standard therapy based on the ASCO/OH non-driver mutations guideline (Moderate recommendation; IC-L). Recommendation 10.2 ➤ For patients with a MET exon 14 skipping mutation, a performance status of 0–2, who have previously received or been ineligible for first-line chemotherapy with or without immunotherapy, clinicians may offer MET-targeted therapy with capmatinib or tepotinib (Moderate recommendation; IC-L). RET Rearrangement First-line Recommendation 11.1 ➤ For patients with a RET rearrangement, a performance status of 0–2, and previously untreated NSCLC, clinicians may offer selpercatinib or pralsetinib (Weak recommendation; IC-L). Recommendation 11.2 ➤ For patients with a RET rearrangement, a performance status of 0–2, previously untreated NSCLC, clinicians may offer standard therapy based on the ASCO/OH non-driver mutation guideline (Moderate recommendation; IC-L). RET Rearrangement Second-line Recommendation 12.1 ➤ For patients with RET rearrangement who have had previous RET- targeted therapy, clinicians may offer treatment per the non-driver mutation guideline (Moderate recommendation; IC-L). Recommendation 12.2 ➤ For patients with RET rearrangement, if RET-targeted therapy was not given in the first-line setting, clinicians may offer selpercatinib (Moderate recommendation; IC-L) or pralestinib (Weak recommendation; IC-L).

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