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晚期或转移性疾病（计划行全身治疗）（NSCL-19）
生物标志物检测结果（NSCL-20）
- EGFR exon 19 deletion or L858R mutation positive NSCL-21
- EGFR S768I, L861Q, and/or G719X mutation positive NSCL-24
- EGFR exon 20 insertion mutation positive NSCL-25
- KRAS G12C mutation positive NSCL-26
- ALK gene fusion positive NSCL-27
- ROS1 gene fusion positive NSCL-30
- BRAF V600E mutation positive NSCL-32
- NTRK1/2/3 gene fusion positive NSCL-33
- MET exon 14 skipping mutation positive NSCL-34
- RET gene fusion positive NSCL-35
- ERBB2 (HER2) mutation positive NSCL-36
- NRG1 gene fusion positive NSCL-37
- PD-L1 ≥1% and negative for actionable biomarkers above NSCL-38
- PD-L1 <1% and negative for actionable biomarkers above NSCL-39
b 病理评估原则（NSCL-A）
d Temel JS, et al. N Engl J Med 2010;363:733-742.
qq Complete biomarker testing including molecular assessment of EGFR, KRAS,ALK, ROS1, BRAF, NTRK1/2/3, MET, RET, ERBB2 (HER2), and NRG1 via biopsy and/or plasma testing. Combinations of tissue and plasma testing, either concurrently or in sequence are acceptable. Concurrent testing can improve time to test results and should be considered in the appropriate clinical situation. Negative results (meaning absence of definitive driver mutation) by one method suggests the use of a complementary method. Treatment is guided by available results and, if unknown, these patients are treated as though they do not have driver oncogenes. For patients who require an urgent start to therapy but biomarker testing is pending, consider holding immunotherapy for one cycle, unless confirmed that no driver mutations are present.
rr 生物标志物分析原则（NSCL-H）.
ss During initial evaluation, the priority should be PD-L1 testing and MGPT; if tissue allows, additional testing can be performed (eg, HER2 IHC or HGF receptor [c-Met] IHC).
tt The NCCN NSCLC Guidelines Panel strongly advises MGPT with the goal of identifying rare driver mutations for which effective drugs may already be available, or to appropriately counsel patients regarding the availability of clinical trials. MGPT is defined as molecular testing that identifies all biomarkers identified in NSCL-20 in either a single assay or a combination of a limited number of assays, and optimally also identifies emerging biomarkers (NSCL-I). Tiered approaches based on low prevalence of co-occurring biomarkers are acceptable. MGPT is a key component of the improvement of care of patients with NSCLC.
See Emerging Biomarkers to Identify Patients for Therapies (NSCL-I).
uu Lam VK, et al. Clin Lung Cancer 2019;20:30-36.e3; Sands JM, et al. Lung Cancer 2020;140:35-41.
NCCN-NSCLC-2026V6
NCCN非小细胞肺癌指南导航
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