11
Summary of Recommendations
Recommendation # Description
1.8 For patients with stage IV NSCLC and driver alterations in
EGFR
• In the first-line setting, for patients with any activating
EGFR mutation (including exon 20 insertion mutations),
regardless of PD-L1 expression levels, single agent
immunotherapy should not be used (Moderate
recommendation: IC-L).
1.9 For patients with stage IV NSCLC and driver alterations in
EGFR causing resistance to first- and second-generation EGFR
tyrosine kinase inhibitors (TKIs)
• In the first-line setting, for patients with EGFR exon 20
insertion mutation causing resistance to first- and second-
generation EGFR TKIs, doublet chemotherapy with or
without bevacizumab or standard treatment outlined in
the ASCO/OH non-driver mutation guideline may be
offered (Moderate recommendation: IC-L).
2.1
2.2
For patients with stage IV NSCLC and driver alterations in
EGFR
• In the second-line setting, for patients who did not receive
osimertinib and have a T790M mutation at the time of
progressive disease, osimertinib should be offered (Strong
recommendation: H).
• In the second-line setting, for patients with any EGFR
mutation who have progressed on EGFR TKIs with no
T790M mutation OR whose disease has progressed on
osimertinib, treatment based on the ASCO/OH non-
driver mutation guideline may be offered (Moderate
recommendation: IC-L).
3.1
3.2
For patients with stage IV NSCLC and driver alterations in ALK
• In the first-line setting, alectinib or brigatinib
(Strong recommendation: H) or loratinib (Weak
recommendation: L) should be offered.
• In the first-line setting, if alectinib and brigatinib or
loratinib are not available, ceritinib or crizotinib should be
offered (Strong recommendation: H).
(cont'd)
