Driving recommendations.

Non-small cell lung cancer (NSCLC) isn’t the catchall it used to be. It’s hard to keep up with the systemic therapy options based on all the current subcategorizations. Since even NCCN can’t keep pace, here are a couple of living documents with consensus recs for metastatic NSCLC. Some highpoints in the updates for disease with driver alterations include a preference for alectinib or brigatinib for ALK-rearranged and trial of selpercatinib or pralsetinib for RET-rearranged NSCLC. Recs for EGFR-rearranged NSCLC get very complicated and require a color-coded graph with decision points based on the exact type of mutation, and there are also recs for rearrangements in ROS1, NTKR, BRAF and MET (Figure 1 is a doozy).  For disease without driver alterations updates include either atezolizumab or cemiplimab monotherapy when PD-L1 expression is at least 50% as well as the option for nivo + ipi +/- platinum-based chemo when PD-L1 expression is <50%. | Singh, J Clin Oncol 2022