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晚期或转移性疾病
EGFR 19号外显子缺失或L858R突变（NSCL-21）
EGFR突变疾病在奥希替尼或兰泽替尼治疗期间进展（NSCL-22）
EGFR突变疾病在阿法替尼、达可替尼、厄洛替尼、吉非替尼治疗期间进展（NSCL-23）
p IGTA therapy (eg, cryotherapy, microwave, radiofrequency) may be an option for select patients. 影像引导下热消融治疗原则（NSCL-D）.
rr 生物标志物分析原则（NSCL-H）.
vv 晚期或转移性疾病的生物标志物指导治疗原则（NSCL-J）
ww For performance status (PS) 0–4.
xx Prophylactic anticoagulation is recommended at the time of initiation to prevent venous thromboembolic events.
yy Prophylaxis with oral doxycycline or minocycline, clindamycin lotion applied to the scalp, chlorhexidine applied to nails, and a ceramide-based noncomedogenic moisturizer is recommended to reduce dermatologic adverse events. Prophylaxis with oral dexamethasone 8 mg for 2 days prior to first dose is recommended to reduce IRRs with amivantamab-vmjw.
zz If systemic therapy regimen contains an immune checkpoint inhibitor (ICI),physicians should be aware of the long half-life of such drugs and data reporting adverse events when using osimertinib in combination with or following checkpoint inhibitors. The rate of side effects (pneumonitis) is higher within 3 months.
Schoenfeld AJ, et al. Ann Oncol 2019;30:839-844; Oshima Y, et al. JAMA Oncol 2018;4:1112-1115; Oxnard GR, et al. Ann Oncol 2020;31:507-516; Gettinger S, et al. J Thorac Oncol 2018;13:1363-1372.
aaa If there is a good response to current therapy, it is reasonable to continue therapy.
bbb Beware of flare phenomenon in subset of patients who discontinue tyrosine kinase inhibitor (TKI). If disease flare occurs, restart TKI.
ccc Clinical trials have included up to 3 to 5 progressing sites.
ddd Consider a biopsy at time of progression to rule out small cell lung cancer(SCLC) transformation (approximately 6%) and biopsy or plasma testing to evaluate mechanisms of resistance. 见 生物标志物分析原则（NSCL-H） and NCCN Guidelines for Small Cell Lung Cancer.
eee Definitive local therapy of CNS disease can include asymptomatic lesions at risk for symptomatic progression based on factors including site, location, and edema.
fff Not an option for EGFR S768I, L861Q, and/or G719X mutations.
ggg Afatinib + Cetuximab may be considered in patients with disease progression on EGFR TKI therapy.
hhh The data in the second-line setting suggest that programmed cell death protein 1 (PD-1)/PD-L1 inhibitor monotherapy is less effective, irrespective of PD-L1 expression, in EGFR exon 19 deletion or L858R mutation, ALK+ NSCLC.
iii Plasma or tissue-based testing via MGPT should be considered at progression for genomic resistance mechanisms. If plasma-based testing is negative, tissue-based testing with rebiopsy material is strongly recommended. Practitioners may want to consider scheduling the biopsy concurrently with plasma testing referral.
jjj Consider Osimertinib (regardless of T790M status) for progressive CNS disease or leptomeningeal disease. In the BLOOM study, osimertinib was used at 160 mg once daily for patients with leptomeningeal disease.
kkk In the randomized phase III trial of dacomitinib, patients with brain metastases were not eligible for enrollment. In the setting of brain metastases, consider other options.
NCCN-NSCLC-2026V6
NCCN非小细胞肺癌指南导航
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