Therapy for stage IV non-small cell lung cancer without driver alterations: ASCO Living Guideline, 2026.3.0

Authors

• Joshua E. Reuss, Georgetown University, Washington, DC.
• Lyudmila Bazhenova, University of California San Diego Moores Cancer Center, San Diego, CA.
• Nofisat Ismaila, American Society of Clinical Oncology (ASCO), Alexandria, VA.
• Fawzi Abu Rous, Henry Ford Cancer Institute/Henry Ford Health System, Detroit, MI.
• Amith Ahluwalia, Confluence Health Wenatchee Valley Hospital and Clinics, Wenatchee, WA.
• Krishna Alluri, Texas Oncology, San Antonio, TX.
• Ibrahim Hanna Azar, IHA Hematology Oncology Consultants, Ypsilanti, MI.
• Toby Campbell, University of Wisconsin, Madison, WI.
• Greg Durm, Indiana University Health, Indianapolis, IN.
• Jill Feldman, EGFR Resisters Patient Advocacy Group, Deerfield, IL.
• Narjust Florez, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA.
• Janet Freeman-Daily, The ROS1ders, Seattle, WA.
• Naoki Furuya, St Marianna University School of Medicine, Kawasaki, Japan.
• Shirish Gadgeel, Henry Ford Cancer Institute/Henry Ford Health System, Detroit, MI.
• Balazs Halmos, Montefiore Einstein Cancer Center, Bronx, NY.
• Hidehito Horinouchi, National Cancer Center Hospital, Tokyo, Japan.
• Sara Kuruvilla, London Health Sciences Centre, London, ON, Canada.
• Gary R. Macvicar, Illinois CancerCare, Peoria, IL.
• Narinder Malhotra, Yolanda G. Barco Cancer Institute, Meadville, PA.
• Kristen Ashley Marrone, John Hopkins Medical Center, Baltimore, MD.
• Deebya Raj Mishra, BP Koirala Institute of Health Sciences, Dharan, Nepal.
• Michael Mullane, Advocate Health - MidwestFollow
• Jarushka Naidoo, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD.
• Dwight H. Owen, Ohio State University, Columbus, OH.
• Bruna Pellini, Miami Cancer Institute, Baptist Health South Florida, Miami, FL.
• Carolyn J. Presley, Ohio State University, Comprehensive Cancer Center and The James Cancer Hospital/Solove Research Institute, Columbus, OH.
• Angel Qin, University of Michigan Health System, Ann Arbor, MI.
• Logan Roof, Ohio State University, Columbus, OH.
• Erin L. Schenk, University of Colorado Anschutz Medical Center, Aurora, CO.
• Lecia Sequist, Massachusetts General Hospital, Boston, MA.
• Navneet Singh, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

Recommended Citation

Reuss JE, Bazhenova L, Ismaila N, et al. Therapy for Stage IV Non-Small Cell Lung Cancer Without Driver Alterations: ASCO Living Guideline, 2026.3.0. J Clin Oncol. 2026;44(7):e56-e88. doi:10.1200/JCO-25-02825

Affiliations

Aurora Cancer Care, Mount Pleasant WI

Abstract

Purpose: To provide evidence-based recommendations for patients with stage IV non-small cell lung cancer (NSCLC) without driver alterations.

Methods: This ASCO living guideline offers continually updated recommendations based on an ongoing systematic review of randomized controlled trials (RCTs), with the latest time frame spanning March-October 2025. An Expert Panel of medical oncology, pulmonary, community oncology, research methodology, and advocacy experts was convened. The literature search included systematic reviews, meta-analyses, and RCTs. Outcomes of interest include efficacy and safety. Expert Panel members used available evidence and informal consensus to develop evidence-based guideline recommendations.

Results: This guideline consolidates all previous updates and reflects the body of evidence informing this guideline topic. Six new RCTs were identified in the latest search of the literature to date.

Recommendations: Evidence-based recommendations were updated to address first, second, and subsequent treatment options for patients without driver alterations.Additional information is available at www.asco.org/thoracic-cancer-guidelines.

Document Type

Article

PubMed ID

41632927