Pan-Asian adapted ESMO Clinical Practice Guidelines for the diagnosis, treatment and follow-up of patients with oncogene-addicted metastatic non-small-cell lung cancer
- Study type
- Clinical guideline
- Study name
- ESMO (Pan-Asian) oncogene-addicted mNSCLC
- Design
- Adaptation of the ESMO clinical guideline (January 2023) using standard ESMO methodology and voting by a panel of Asian experts
- Source
- ESMO Open · 2024
In plain words
This guideline, based on the European ESMO guideline and prepared with experts from Asian countries, stresses that in advanced lung cancer the tumour should be tested for gene changes (especially EGFR and ALK), and if these changes are found, treatment with targeted tablets should be started.
Key guideline recommendations
- IV, A
Adequate tissue for histological diagnosis and molecular testing should be obtained to allow individualised treatment decisions.
- I, A
EGFR mutation status should be determined; the test method should adequately cover mutations in exons 18 to 21.
- I, A
Testing for ALK rearrangement should be performed.
- II, A
Testing for MET exon 14 skipping mutation, MET amplification, RET rearrangement, KRAS G12C mutation and HER2 mutations should be performed; where available, multiplex platforms (NGS) are preferred [III, A].
- I, A
All patients with a sensitising EGFR mutation should receive a first-line EGFR tyrosine kinase inhibitor regardless of performance status, sex, smoking history and histology.
- I, A; ESMO-MCBS 4
Third-generation EGFR inhibitors (such as osimertinib) are the preferred first-line option for classic mutations (exon 19 deletion or L858R), especially in patients with central nervous system metastases.
- I, A
Another first-line option for classic EGFR mutations is osimertinib plus carboplatin–pemetrexed [I, A] or lazertinib plus amivantamab [I, A] (neither was EMA-approved at the time of publication).
- I, A; ESMO-MCBS 4
In ALK-positive NSCLC, alectinib, brigatinib, ensartinib or lorlatinib are recommended first line and are preferred over crizotinib or ceritinib [I, B].
- III, A
In ROS1-positive NSCLC, crizotinib or entrectinib is recommended first line; in the presence of brain metastases, entrectinib (where available) is preferred over crizotinib.
- III, A
For BRAF V600 mutation, BRAF–MEK inhibition with dabrafenib–trametinib is recommended; encorafenib–binimetinib is an alternative.
Study population
Patients with metastatic NSCLC harbouring targetable oncogenic alterations; levels of evidence and grades of recommendation according to the ESMO system (I to V; A to E).
Clinical significance and place in guidelines
This document reflects all recommendations of the 2023 ESMO guideline for oncogene-addicted metastatic NSCLC, with ESMO levels of evidence and grades of recommendation, and is particularly relevant for Asian populations with a higher prevalence of EGFR mutations. The original ESMO guideline (Hendriks et al., Ann Oncol 2023; DOI: 10.1016/j.annonc.2022.12.009) and its living updates are available on the ESMO website.
Limitations
This is a regional adaptation, and some recommendations were modified for drug access in Asia; overall survival data from FLAURA2 and MARIPOSA were published after it was prepared.
This summary was prepared by the editorial team from the published paper; the original paper is the final reference. Read the original abstract on PubMed.