Literature search
Process of guideline development
Level | Strength | Example |
---|---|---|
A | High | Several high-quality studies with consistent results |
B | Moderate | One high-quality study |
C | Low | Studies with severe limitations |
D | Very low | Studies with very severe limitations or expert opinion |
Recommendation level | Direction |
---|---|
1 (strong) | To do (= recommend to do) |
2 (weak) | To do (= suggest to do) |
1 (strong) | Not to do (= recommend not to do) |
2 (weak) | Not to do (= suggest not to do) |
Outline
Driver oncogene-positive |
---|
Treatment of driver oncogene-positive patients (non-squamous cell lung cancer)
|
CQ 1. What is the optimal first-line treatment for patients who have driver oncogene with good PS (0–1)? |
CQ 2. What is the optimal first-line treatment for patients who have driver oncogene with poor PS (2–4)? |
CQ 3. What is the optimal first-line treatment for elderly (≥ 75 years) patients who have driver oncogene? |
CQ 4. Is cytotoxic chemotherapy recommended for patients who have driver oncogene? |
CQ 5. Is combination of cytotoxic chemotherapy and ICI recommended for patients who have driver oncogene? |
CQ 6. Is ICI recommended for patients who have driver oncogene? |
EGFR-mutated
, non-squamous cell lung cancer
|
First-line treatment in patients who have EGFR mutation (exon 19 deletion or L858R mutation)
|
CQ 7. What is the recommended first-line treatment in patients who have EGFR mutation (exon 19 deletion or L858R mutation) with PS of 0–1? |
CQ 8. What is the recommended first-line treatment in patients who have EGFR mutation (exon 19 deletion or L858R mutation) with PS of 2? |
CQ 9. What is the recommended first-line treatment in patients who have EGFR mutation (exon 19 deletion or L858R mutation) with PS of 3–4? |
First-line treatment of those patients who have EGFR mutation other than exon 19 deletion or L858R mutation
|
CQ 10. What is the recommended first-line treatment in patients who have EGFR mutation other than exon 19 deletion or L858R mutation, with PS of 0–1? |
Second-line and further treatment of those patients who have EGFR mutation
|
CQ 11. What is the recommended second-line treatment in patients with EGFR T790M mutation after progression of EGFR-TKIs? |
ALK rearranged
, non-squamous cell lung cancer
|
First-line treatment of those patients who have ALK rearrangement
|
CQ 12. What is the recommended first-line treatment in patients who have ALK rearrangement with PS of 0–1? |
CQ 13. What is the recommended first-line treatment in patients who have ALK rearrangement with PS of 2–4? |
Second-line treatment of those patients who have ALK rearrangement
|
CQ 14. What is the recommended second-line treatment in patients with ALK rearrangement after progression of ALK-TKIs? |
ROS1 rearranged
, non-squamous cell lung cancer
|
CQ 15. Is crizotinib a recommended treatment in patients who have ROS1 rearrangement? |
BRAF mutated
, non-squamous cell lung cancer
|
CQ 16. Is dabrafenib plus trametinib a recommended treatment in patients who have BRAF mutation? |
Driver oncogene-positive, squamous cell lung cancer
|
CQ 17. Is tyrosine-kinase inhibitor a recommended treatment in squamous cell lung cancer patients who have driver oncogene? |
PD-L1 ≥ 50% |
---|
CQ 18. What is the recommended first-line treatment in patients with PS 0-1 and whose tumor is positive for PD-L1 ≥ 50%? |
CQ 19. What is the recommended first-line treatment in patients with PS 2 and whose tumor is positive for PD-L1 ≥ 50%? |
Driver oncogene-negative and PD-L1 < 50%, or unknown |
---|
First-line treatment in patients who are driver oncogene-negative and PD-L1 < 50%, or unknown
|
CQ 20. Is cytotoxic chemotherapy recommended as a first-line treatment in patients with PS 0–1 and younger than 75 years old, when their tumor is driver oncogene-negative and PD-L1 is < 50%, or unknown? |
CQ 21. Is cytotoxic chemotherapy recommended as a first-line treatment in patients with PS 0–1 and older than 75 years old, when their tumor is driver oncogene-negative and PD-L1 is < 50%, or unknown? |
CQ 22. Is cytotoxic chemotherapy recommended as a first-line treatment in patients with PS 2, when their tumor is driver oncogene-negative and PD-L1 is < 50%, or unknown? |
CQ 23. Is addition of PD-1/PD-L1 inhibitor to platinum- containing chemotherapy recommended in patients with PS 0–2, when their tumor is driver oncogene-negative and PD-L1 is < 50%, or unknown? |
CQ 24. What is the recommended number of courses of platinum-containing chemotherapy? |
CQ 25. Is addition of bevacizumab to platinum-doublet chemotherapy recommended in patients with PS 0–2? |
CQ 26. Is maintenance therapy recommended in patients who received four courses of platinum-containing chemotherapy without disease progression and with tolerable toxicity? |
CQ 27. Is chemotherapy recommended in patients with PS 3–4, when their tumor is driver oncogene-negative or unknown? |
Second- or further-line treatment in patients who are driver oncogene-negative and PD-L1 is < 50 unknown
|
CQ 28. Is chemotherapy recommended as a second- or further-line treatment in patients with PS 0–2 who progressed with first-line treatment other than PD-1/PD-L1 inhibitor? |
CQ 29. What is the recommended chemotherapy as the second- or further-line treatment in patients with PS 0–2? |
CQ 30. Is addition of RAM to DTX recommended in the second-line treatment? |
CQ 31. Is erlotinib recommended in the second-line treatment? |
Driver oncogene-positive
Treatment of driver oncogene-positive patients (non-squamous cell lung cancer) (Fig. 3)
CQ 1
Benefit with strong recommendation | Benefit with weak recommendation | Unable to determine recommendation | No benefit or risk with weak recommendation | No benefit or risk with strong recommendation |
---|---|---|---|---|
100% (27/27) | 0 | 0 | 0 | 0 |
CQ 2
Benefit with strong recommendation | Benefit with weak recommendation | Unable to determine recommendation | No benefit or risk with weak recommendation | No benefit or risk with strong recommendation |
---|---|---|---|---|
96% (27/28) | 4% (1/28) | 0 | 0 | 0 |
Benefit with strong recommendation | Benefit with weak recommendation | Unable to determine recommendation | No benefit or risk with weak recommendation | No benefit or risk with strong recommendation |
---|---|---|---|---|
7% (2/28) | 93% (26/28) | 0 | 0 | 0 |
CQ 3
Benefit with strong recommendation | Benefit with weak recommendation | Unable to determine recommendation | No benefit or risk with weak recommendation | No benefit or risk with strong recommendation |
---|---|---|---|---|
96% (27/28) | 4% (1/28) | 0 | 0 | 0 |
CQ 4
Benefit with strong recommendation | Benefit with weak recommendation | Unable to determine recommendation | No benefit or risk with weak recommendation | No benefit or risk with strong recommendation |
---|---|---|---|---|
100% (28/28) | 0 | 0 | 0 | 0 |
CQ 5
Benefit with strong recommendation | Benefit with weak recommendation | Unable to determine recommendation | No benefit or risk with weak recommendation | No benefit or risk with strong recommendation |
---|---|---|---|---|
0% | 30% (7/23) | 65% (15/23) | 0 | 4% (1/23) |
CQ 6
Benefit with strong recommendation | Benefit with weak recommendation | Unable to determine recommendation | No benefit or risk with weak recommendation | No benefit or risk with strong recommendation |
---|---|---|---|---|
0% | 23% (5/22) | 73% (16/22) | 0 | 5% (1/22) |
EGFR-mutated, non-squamous cell lung cancer
CQ 7
Benefit with strong recommendation | Benefit with weak recommendation | Unable to determine recommendation | No benefit or risk with weak recommendation | No benefit or risk with strong recommendation |
---|---|---|---|---|
83% (19/23) | 17% (4/23) | 0 | 0 | 0 |
Benefit with strong recommendation | Benefit with weak recommendation | Unable to determine recommendation | No benefit or risk with weak recommendation | No benefit or risk with strong recommendation |
---|---|---|---|---|
13% (3/23) | 83% (19/23) | 0 | 4% (1/23) | 0 |
Benefit with strong recommendation | Benefit with weak recommendation | Unable to determine recommendation | No benefit or risk with weak recommendation | No benefit or risk with strong recommendation |
---|---|---|---|---|
0 | 100% (23/23) | 0 | 0 | 0 |
Benefit with strong recommendation | Benefit with weak recommendation | Unable to determine recommendation | No benefit or risk with weak recommendation | No benefit or risk with strong recommendation |
---|---|---|---|---|
4% (1/23) | 92% (21/23) | 0 | 4% (1/23) | 0 |
Benefit with strong recommendation | Benefit with weak recommendation | Unable to determine recommendation | No benefit or risk with weak recommendation | No benefit or risk with strong recommendation |
---|---|---|---|---|
0 | 92% (21/23) | 4% (1/23) | 4% (1/23) | 0 |
CQ 8
Benefit with strong recommendation | Benefit with weak recommendation | Unable to determine recommendation | No benefit or risk with weak recommendation | No benefit or risk with strong recommendation |
---|---|---|---|---|
100% (24/24) | 0 | 0 | 0 | 0 |
CQ 9
Benefit with strong recommendation | Benefit with weak recommendation | Unable to determine recommendation | No benefit or risk with weak recommendation | No benefit or risk with strong recommendation |
---|---|---|---|---|
75% (18/24) | 25% (6/24) | 0 | 0 | 0 |
CQ 10
Benefit with strong recommendation | Benefit with weak recommendation | Unable to determine recommendation | No benefit or risk with weak recommendation | No benefit or risk with strong recommendation |
---|---|---|---|---|
13% (3/24) | 87% (21/24) | 0 | 0 | 0 |
Benefit with strong recommendation | Benefit with weak recommendation | Unable to determine recommendation | No benefit or risk with weak recommendation | No benefit or risk with strong recommendation |
---|---|---|---|---|
0% | 4% (1/27) | 0 | 26% (7/27) | 70% (19/27) |
Benefit with strong recommendation | Benefit with weak recommendation | Unable to determine recommendation | No benefit or risk with weak recommendation | No benefit or risk with strong recommendation |
---|---|---|---|---|
4% (1/27) | 67% (18/27) | 29% (8/27) | 0 | 0 |
CQ 11
Benefit with strong recommendation | Benefit with weak recommendation | Unable to determine recommendation | No benefit or risk with weak recommendation | No benefit or risk with strong recommendation |
---|---|---|---|---|
100% (26/26) | 0 | 0 | 0 | 0 |
ALK-rearranged, non-squamous cell lung cancer
CQ 12
Benefit with strong recommendation | Benefit with weak recommendation | Unable to determine recommendation | No benefit or risk with weak recommendation | No benefit or risk with strong recommendation |
---|---|---|---|---|
100% (27/27) | 0 | 0 | 0 | 0 |
Benefit with strong recommendation | Benefit with weak recommendation | Unable to determine recommendation | No benefit or risk with weak recommendation | No benefit or risk with strong recommendation |
---|---|---|---|---|
0 | 96% (26/27) | 0 | 0 | 4% (1/27) |
Benefit with strong recommendation | Benefit with weak recommendation | Unable to determine recommendation | No benefit or risk with weak recommendation | No benefit or risk with strong recommendation |
---|---|---|---|---|
0 | 96% (26/27) | 0 | 0 | 4% (1/27) |
CQ 13
Benefit with strong recommendation | Benefit with weak recommendation | Unable to determine recommendation | No benefit or risk with weak recommendation | No benefit or risk with strong recommendation |
---|---|---|---|---|
100% (27/27) | 0 | 0 | 0 | 0 |
CQ 14
Benefit with strong recommendation | Benefit with weak recommendation | Unable to determine recommendation | No benefit or risk with weak recommendation | No benefit or risk with strong recommendation |
---|---|---|---|---|
96% (25/26) | 4% (1/26) | 0 | 0 | 0 |
Benefit with strong recommendation | Benefit with weak recommendation | Unable to determine recommendation | No benefit or risk with weak recommendation | No benefit or risk with strong recommendation |
---|---|---|---|---|
0 | 100% (26/26) | 0 | 0 | 0 |
Benefit with strong recommendation | Benefit with weak recommendation | Unable to determine recommendation | No benefit or risk with weak recommendation | No benefit or risk with strong recommendation |
---|---|---|---|---|
4% (1/26) | 96% (25/26) | 0 | 0 | 0 |
ROS1 rearranged, non-squamous cell lung cancer (Fig. 8)
CQ 15
Benefit with strong recommendation | Benefit with weak recommendation | Unable to determine recommendation | No benefit or risk with weak recommendation | No benefit or risk with strong recommendation |
---|---|---|---|---|
100% (26/26) | 0 | 0 | 0 | 0 |
BRAF-mutated, non-squamous cell lung cancer (Fig. 9)
CQ 16
Benefit with strong recommendation | Benefit with weak recommendation | Unable to determine recommendation | No benefit or risk with weak recommendation | No benefit or risk with strong recommendation |
---|---|---|---|---|
58% (15/26) | 42% (11/26) | 0 | 0 | 0 |
Benefit with strong recommendation | Benefit with weak recommendation | Unable to determine recommendation | No benefit or risk with weak recommendation | No benefit or risk with strong recommendation |
---|---|---|---|---|
69% (18/26) | 31% (8/26) | 0 | 0 | 0 |
Driver oncogene-positive, squamous cell lung cancer
CQ 17
Benefit with strong recommendation | Benefit with weak recommendation | Unable to determine recommendation | No benefit or risk with weak recommendation | No benefit or risk with strong recommendation |
---|---|---|---|---|
15% (4/26) | 85% (22/26) | 0 | 0 | 0 |
PD-L1 ≥ 50% (Fig. 10)
CQ 18
Benefit with strong recommendation | Benefit with weak recommendation | Unable to determine recommendation | No benefit or risk with weak recommendation | No benefit or risk with strong recommendation |
---|---|---|---|---|
96% (26/27) | 4% (1/27) | 0 | 0 | 0 |
Benefit with strong recommendation | Benefit with weak recommendation | Unable to determine recommendation | No benefit or risk with weak recommendation | No benefit or risk with strong recommendation |
---|---|---|---|---|
69% (18/26) | 31% (8/26) | 0 | 0 | 0 |
CQ 19
Benefit with strong recommendation | Benefit with weak recommendation | Unable to determine recommendation | No benefit or risk with weak recommendation | No benefit or risk with strong recommendation |
---|---|---|---|---|
0 | 85% (22/26) | 15% (4/26) | 0 | 0 |
Benefit with strong recommendation | Benefit with weak recommendation | Unable to determine recommendation | No benefit or risk with weak recommendation | No benefit or risk with strong recommendation |
---|---|---|---|---|
0 | 0 | 69% (18/26) | 27% (7/26) | 4% (1/26) |
Driver oncogene-negative and PD-L1 < 50%, or unknown
First-line treatment in patients who are driver oncogene-negative and PD-L1 < 50%, or unknown is shown in Fig. 11
CQ 20
Benefit with strong recommendation | Benefit with weak recommendation | Unable to determine recommendation | No benefit or risk with weak recommendation | No benefit or risk with strong recommendation |
---|---|---|---|---|
93% (25/27) | 7% (2/27) | 0 | 0 | 0 |
CQ 21
Benefit with strong recommendation | Benefit with weak recommendation | Unable to determine recommendation | No benefit or risk with weak recommendation | No benefit or risk with strong recommendation |
---|---|---|---|---|
100% (27/27) | 0 | 0 | 0 | 0 |
Benefit with strong recommendation | Benefit with weak recommendation | Unable to determine recommendation | No benefit or risk with weak recommendation | No benefit or risk with strong recommendation |
---|---|---|---|---|
26% (7/27) | 74% (20/27) | 0 | 0 | 0 |
CQ 22
Benefit with strong recommendation | Benefit with weak recommendation | Unable to determine recommendation | No benefit or risk with weak recommendation | No benefit or risk with strong recommendation |
---|---|---|---|---|
100% (27/27) | 0 | 0 | 0 | 0 |
Benefit with strong recommendation | Benefit with weak recommendation | Unable to determine recommendation | No benefit or risk with weak recommendation | No benefit or risk with strong recommendation |
---|---|---|---|---|
0 | 100% (27/27) | 0 | 0 | 0 |
CQ 23
Benefit with strong recommendation | Benefit with weak recommendation | Unable to determine recommendation | No benefit or risk with weak recommendation | No benefit or risk with strong recommendation |
---|---|---|---|---|
78% (21/27) | 22% (6/27) | 0 | 0 | 0 |
Benefit with strong recommendation | Benefit with weak recommendation | Unable to determine recommendation | No benefit or risk with weak recommendation | No benefit or risk with strong recommendation |
---|---|---|---|---|
0 | 0 | 74% (20/27) | 22% (6/27) | 4% (1/27) |
CQ 24
Benefit with strong recommendation | Benefit with weak recommendation | Unable to determine recommendation | No benefit or risk with weak recommendation | No benefit or risk with strong recommendation |
---|---|---|---|---|
100% (26/26) | 0 | 0 | 0 | 0 |
CQ 25
Benefit with strong recommendation | Benefit with weak recommendation | Unable to determine recommendation | No benefit or risk with weak recommendation | No benefit or risk with strong recommendation |
---|---|---|---|---|
27% (7/26) | 73% (19/26) | 0 | 0 | 0 |
Benefit with strong recommendation | Benefit with weak recommendation | Unable to determine recommendation | No benefit or risk with weak recommendation | No benefit or risk with strong recommendation |
---|---|---|---|---|
0 | 0 | 4% (1/26) | 96% (25/26) | 0 |
Benefit with strong recommendation | Benefit with weak recommendation | Unable to determine recommendation | No benefit or risk with weak recommendation | No benefit or risk with strong recommendation |
---|---|---|---|---|
0 | 0 | 4% (1/26) | 92% (24/26) | 4% (1/26) |
CQ 26
Benefit with strong recommendation | Benefit with weak recommendation | Unable to determine recommendation | No benefit or risk with weak recommendation | No benefit or risk with strong recommendation |
---|---|---|---|---|
100% (26/26) | 0 | 0 | 0 | 0 |
Benefit with strong recommendation | Benefit with weak recommendation | Unable to determine recommendation | No benefit or risk with weak recommendation | No benefit or risk with strong recommendation |
---|---|---|---|---|
12% (3/26) | 88% (23/26) | 0 | 0 | 0 |
Benefit with strong recommendation | Benefit with weak recommendation | Unable to determine recommendation | No benefit or risk with weak recommendation | No benefit or risk with strong recommendation |
---|---|---|---|---|
0 | 0 | 0 | 0 | 100% (25/25) |
CQ 27
Benefit with strong recommendation | Benefit with weak recommendation | Unable to determine recommendation | No benefit or risk with weak recommendation | No benefit or risk with strong recommendation |
---|---|---|---|---|
0 | 0 | 0 | 0 | 100% (25/25) |
Second- or further-line treatment in patients who are driver oncogene-negative and PD-L1 is < 50% or unknown (Fig. 12)
CQ 28
Benefit with strong recommendation | Benefit with weak recommendation | Unable to determine recommendation | No benefit or risk with weak recommendation | No benefit or risk with strong recommendation |
---|---|---|---|---|
100% (23/23) | 0 | 0 | 0 | 0 |
Benefit with strong recommendation | Benefit with weak recommendation | Unable to determine recommendation | No benefit or risk with weak recommendation | No benefit or risk with strong recommendation |
---|---|---|---|---|
0 | 96% (22/23) | 4% (1/23) | 0 | 0 |
CQ 29
Benefit with strong recommendation | Benefit with weak recommendation | Unable to determine recommendation | No benefit or risk with weak recommendation | No benefit or risk with strong recommendation |
---|---|---|---|---|
100% (23/23) | 0 | 0 | 0 | 0 |
CQ 30
Benefit with strong recommendation | Benefit with weak recommendation | Unable to determine recommendation | No benefit or risk with weak recommendation | No benefit or risk with strong recommendation |
---|---|---|---|---|
26% (6/23) | 74% (17/23) | 0 | 0 | 0 |
Benefit with strong recommendation | Benefit with weak recommendation | Unable to determine recommendation | No benefit or risk with weak recommendation | No benefit or risk with strong recommendation |
---|---|---|---|---|
0 | 9% (2/23) | 9% (2/23) | 78% (18/23) | 4% (1/23) |
Benefit with strong recommendation | Benefit with weak recommendation | Unable to determine recommendation | No benefit or risk with weak recommendation | No benefit or risk with strong recommendation |
---|---|---|---|---|
0 | 0 | 9% (2/23) | 87% (20/23) | 4% (1/23) |
CQ 31
Benefit with strong recommendation | Benefit with weak recommendation | Unable to determine recommendation | No benefit or risk with weak recommendation | No benefit or risk with strong recommendation |
---|---|---|---|---|
0 | 13% (3/23) | 17% (4/23) | 65% (15/23) | 4% (1/23) |