Therapy for Stage IV Non-Small Cell Lung Cancer With Driver Alterations: ASCO Living Guideline, 2026.3.0.

Puri, S., Leighl, N. B., Ismaila, N., Rous, F. A., Ahluwalia, A., Alluri, K., Azar, I. H., Campbell, T., Durm, G., Feldman, J., Florez, N., Freeman-Daily, J., Furuya, N., Gadgeel, S., Halmos, B., Horinouchi, H., Kuruvilla, S., Macvicar, G. R., Malhotra, N., … Bazhenova, L. (2026). Therapy for Stage IV Non-Small Cell Lung Cancer With Driver Alterations: ASCO Living Guideline, 2026.3.0.. Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology, 44(7), e15-e55.

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.

Last updated on 04/01/2026
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