In the most recent edition of our Guidelines Timeline Series, we explore the American Society of Clinical Oncology’s (ASCO) guideline on Stage IV Non-Small Cell Lung Cancer without Driver Alterations, which was published on February 28, 2024. This guideline was introduced by ASCO as a living document, that is continuously updated to reflect the latest research and clinical practices as new evidence emerges.

This updated clinical practice guideline incorporates findings from ten new randomized clinical trials (RCTs) identified in the most recent literature search. The guideline authors aim to address two key clinical questions: (1) What are the most effective first-line treatment options for patients with stage IV NSCLC without driver alterations, based on cancer subtype? (2) What are the most effective second-line and subsequent treatment options for patients with stage IV NSCLC without driver alterations based on cancer subtype?

Below, we highlight the key aspects of Stage IV Non-Small Cell Lung Cancer (NSCLC) without driver alterations as outlined by ASCO, showcasing the latest advancements in this edition as compared to the previous versions.

Please note, after the society’s thorough review of the additional studies identified by the expert panel in the literature search dated January 19, 2024, it was determined that the study results do not warrant an update to the recommendations presented here.

Guidelines Referenced

Major Changes (2024 vs 2022 ) 

The 2024 version of the treatment guidelines represents a comprehensive update that includes additional studies and options for treatment. One of the key differences between the 2024 and 2022 versions is the updated first-line therapy recommendations for non-squamous NSCLC with PD-L1 expression TPS ≥50%.

In the 2024 version, clinicians now have the option to choose single-agents pembrolizumab, cemiplimab, or atezolizumab for non-squamous NSCLC with PD-L1 expression TPS ≥50%. This is a notable change from the earlier version, which only offered single-agents atezolizumab or cemiplimab.

Additionally, the 2024 version introduces new topics such as Patient and Clinician Communication, Health Disparities, and Special Populations. It emphasizes the importance of providing patients with information about the benefits and burdens of treatment options, fostering shared decision making, and addressing health disparities that may impact access to care.

Special attention is given to patients with multiple chronic conditions, who may require tailored treatment plans due to their complex needs. The guidelines also highlight the challenges faced by patients with poor performance status or advanced age, emphasizing the importance of shared decision making in implementing guideline-recommended care.

Overall, the 2024 version of the treatment guidelines offers a more comprehensive and up-to-date resource for clinicians to provide the highest level of cancer care to their patients.

We are grateful for your ongoing interest, and we encourage you to stay informed about upcoming segments in our series. We value your feedback and would like to hear your suggestions for future topics to be covered in our guideline series. Please feel free to contact us with any ideas or questions you may have.

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