Therapy for stage IV non-small cell lung cancer with driver alterations: ASCO Living Guideline, 2026.3.0

Authors

• Sonam Puri, Moffitt Cancer Center, Tampa, FL.
• Natasha B. Leighl, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.
• 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 Comprehensive 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

Puri S, Leighl NB, Ismaila N, et al. Therapy for Stage IV Non-Small Cell Lung Cancer With Driver Alterations: ASCO Living Guideline, 2026.3.0. J Clin Oncol. 2026;44(7):e15-e55. doi:10.1200/JCO-25-02822

Affiliations

Aurora Cancer Care, Mount Pleasant WI

Abstract

Purpose: To provide evidence-based recommendations for patients with stage IV non-small cell lung cancer with 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. Thirteen studies were identified in the latest search of literature to date.

Recommendations: Evidence-based recommendations were updated to address first, second, and subsequent treatment options for patients with driver alterations.Additional information is available at www.asco.org/thoracic-cancer-guidelines.

Document Type

Letter

PubMed ID

41632926