ASCO Living Guideline：IV期 NSCLC Driver Alterations

类型: 指南 发表日期: 2025-04 入库日期: 2026-05-21 来源: Journal of Clinical Oncology / ASCO 标签: ASCO, EGFR L858R, IV期NSCLC, 指南, 奥希替尼, Amivantamab, NGS

Citation

Therapy for Stage IV Non-Small Cell Lung Cancer With Driver Alterations: ASCO Living Guideline, Version 2024.3. Journal of Clinical Oncology. DOI: 10.1200/JCO-24-02785

Earlier update with FLAURA2: Version 2024.1

Why this is in CCL

This is a clinician guideline rather than a single trial. It helps translate trials into decision points for stage IV NSCLC with driver alterations, including EGFR L858R.

Key takeaways

• For EGFR exon 19 deletion or L858R, first-line options now include osimertinib-based therapy and selected combination strategies.
• ASCO emphasizes reassessing for new targetable resistance mechanisms using tissue and/or blood NGS after EGFR TKI progression.
• For progression after osimertinib or another EGFR TKI without emergent T790M or other targetable alteration, ASCO notes platinum-based chemotherapy with or without amivantamab as an option.

Practical relevance

• Supports repeat NGS as a core action at confirmed progression.
• Useful for framing second-line discussions: “Is there a targetable resistance mechanism?” comes before “Which empiric regimen?”
• The guideline is US/ASCO oriented; local China availability and physician judgment still matter.