Guidance
Update information
March 2024: We have removed the following systemic anti-cancer therapy treatment pathways for advanced non-small-cell lung cancer after the withdrawal of the NICE technology appraisal guidance on mobocertinib:
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EGFRex 20 insertion positive, PD-L1 less than 50%, for both squamous and non-squamous non-small-cell lung cancer
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EGFRex 20 insertion positive, PD-L1 50% or higher, for both squamous and non-squamous non-small-cell lung cancer.
July 2023: We have made the following changes to the systemic anti-cancer therapy treatment pathways for advanced non-small-cell lung cancer:
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added the NICE technology appraisal guidance on dabrafenib and trametinib, for squamous and non-squamous non-small-cell lung cancer
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added the NICE technology appraisal guidance on mobocertinib, for non-squamous non-small-cell lung cancer
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added the NICE technology appraisal guidance on selpercatinib, for squamous and non-squamous non-small-cell lung cancer
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updated the treatment options in the pathways for EGFR-TK positive, KRAS G12C positive and METex14 skipping alteration non-small-cell lung cancer.
March 2023: We added the NICE technology appraisal guidance on mobocertinib to the systemic anti-cancer therapy treatment pathways for advanced non-small-cell lung cancer.
September 2022: We added the NICE technology appraisal guidance on tepotinib to the systemic anti-cancer therapy treatment pathways for advanced non-small-cell lung cancer.
August 2022: We have changed how the information on systemic anti-cancer therapy for advanced non-small-cell lung cancer is presented.
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In the 2019 version of the guideline, this information was presented both in separate visual summaries, and as recommendations in the guideline.
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In the 2022 update, this information is presented in separate treatment pathways. The recommendations have been incorporated into the treatment pathways and have been removed from the guideline. This is a presentational change only, and the recommendations still apply.
The sources for the 2019 and 2022 versions are the same:
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NICE technology appraisal guidance
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Recommendations from the 2019 version of the guideline that have been incorporated into the treatment pathways
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Input from the 2019 guideline committee and other topic experts.
The 2022 treatment pathways were developed following an interim process to develop visualisations of treatment options.
March 2019: We reviewed the evidence and made new recommendations on mediastinal lymph node assessment, brain imaging, prophylactic cranial irradiation, radical radiotherapy and operable stage IIIA disease. These recommendations are marked [2019].
We also made some changes without an evidence review:
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Recommendations 1.3.2, 1.3.10, 1.3.14, 1.3.15, 1.4.13, 1.4.16 and 1.4.38 were updated to fit with the recommendations made in the 2019 evidence review, and to reflect current best practice.
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Recommendations 1.3.5, 1.3.11, 1.3.18 were updated to reflect current terminology.
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Recommendation 1.3.17 has had 'fibreoptic' removed, because bronchoscopy can be fibreoptic, video or hybrid.
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Recommendation 1.3.30 has had a reference to the Welsh Government and Department of Health removed, as the NHS England optimal lung cancer pathway now covers this area.
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Recommendation 1.3.34 was updated to reflect current practice and to be in line with the NICE quality standard on lung cancer.
These recommendations are marked [2005, amended 2019] or [2011, amended 2019].
Recommendations marked [2005] or [2011] last had an evidence review in 2005 or 2011. In some cases minor changes have been made to the wording to bring the language and style up to date, without changing the meaning.
The 2019 visual summaries were developed following a process to develop a systemic anti-cancer therapy algorithm.
ISBN: 978-1-4731-5818-4