Update information

March 2024: We have removed the following systemic anticancer therapy treatment pathways for advanced non-small-cell lung cancer (NSCLC) after the withdrawal of the NICE technology appraisal guidance on mobocertinib:

EGFRex 20 insertion positive, PD-L1 below 50%, for both squamous and non-squamous NSCLC
EGFRex 20 insertion positive, PD-L1 50% or higher, for both squamous and non-squamous NSCLC.

July 2023: We have made the following changes to the systemic anticancer therapy treatment pathways for advanced NSCLC:

added the NICE technology appraisal guidance on dabrafenib and trametinib, for squamous and non-squamous NSCLC
added the NICE technology appraisal guidance on selpercatinib, for squamous and non-squamous NSCLC
updated the treatment options in the pathways for EGFR-TK positive, KRAS G12C positive and METex14 skipping alteration NSCLC.

March 2023: We added the NICE technology appraisal guidance on mobocertinib to the systemic anticancer therapy treatment pathways for advanced NSCLC.

September 2022: We added the NICE technology appraisal guidance on tepotinib to the systemic anticancer therapy treatment pathways for advanced NSCLC.

August 2022: We have changed how the information on systemic anticancer therapy for advanced NSCLC is presented.

In the 2019 version of the guideline, this information was presented both in separate visual summaries, and as recommendations in the guideline.
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:

NICE technology appraisal guidance
Recommendations from the 2019 version of the guideline that have been incorporated into the treatment pathways
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 3a disease. These recommendations are marked [2019].

We also made some changes without an evidence review. 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 anticancer therapy algorithm.

Minor changes since publication

February 2026: We added links to relevant technology appraisal guidance in the section on management. Recommendation 1.2.12 has been amended to change from single mutation testing to current standard practice, which is comprehensive next generation sequencing (NGS) panels through genomic laboratory hubs. We also simplified the guideline by removing recommendations on general principles of care that are covered in other NICE guidelines.

ISBN: 978-1-4731-5818-4