10
Treatment
Summary of Recommendations
Recommendation # Description
1.1 For patients with stage IV NSCLC and driver alterations in
EGFR
• In the first-line setting, for patients with T790M, L858R
or exon 19 deletion mutations, osimertinib should be
offered (Strong recommendation: H).
1.2
1.3
1.4
1.5
For patients with stage IV NSCLC and driver alterations in
EGFR–If osimertinib is not available
• In the first-line setting, if osimertinib is not available,
gefitinib with chemotherapy may be offered or dacomitinib
may be offered (Moderate recommendation: H).
• Other options that may be offered include: afatinib
or erlotinib/bevacizumab or erlotinib/ramucirumab
or gefitinib, erlotinib, or icotinib (Moderate
recommendation: I).
1.6 For patients with stage IV NSCLC and driver alterations in
EGFR
• In the first-line setting, for patients with a performance
status of 3, an EGFR tyrosine kinase inhibitor may be
offered (Weak recommendation: IC-L).
1.7 For patients with stage IV NSCLC and driver alterations in
EGFR
• In the first-line setting, for patients with EGFR mutations
other than exon 20 insertion mutations, T790M, L858R
or exon 19 deletion alterations, afatinib may be offered
(Moderate recommendation: IC-L) or osimertinib may
be offered (Weak recommendation: IC-L) or treatments
outlined in the ASCO/OH non-driver mutation guideline
may be offered (Moderate recommendation: IC-L).
