Table 3.

Summary of recommendations

	Recommendations
Diagnosis
	Pathological diagnosis should be made according to the WHO classification and IASLC classification of adenocarcinoma For therapeutic implications, specific subtyping of NSCLC is strongly recommended whenever possible Limited panel of immunohistochemistry markers is strongly recommended in order to preserve as much tissue as possible for further molecular assessments Testing for EGFR mutations and ALK translocations are recommended in all patients with advanced-stage non-SCC, regardless of clinical characteristics and in never smokers irrespective of histology
Stage I–II
Patients medically fit for surgery	Lobectomy plus systematic lymph node sampling or dissection
Patients medically inoperable, node negative, tumors < 5 cm	SBRT
Post-operative radiotherapy (PORT)	Not indicated in completely resected stage I-II
Adjuvant chemotherapy (four cycles of adjuvant cisplatin-based chemotherapy	Not indicated in stage IA May be considered in selected patients with stage IB Recommended in stage II
Targeted agents	Not recommended
Stage III
Postoperative IIIA (N2)	Adjuvant platinum-based chemotherapy ± PORT
Preoperative resectable IIIA (N2)	Definitive concurrent chemo/radiotherapy Induction chemotherapy or induction chemoradiotherapy followed by surgery evaluation
Unresectable IIIA (N2), IIIB	PS 0-1: definitive concurrent chemoradiotherapy PS 2: sequential chemoradiotherapy
Stage IV without driver mutations
First line setting For PS 0-1, platinum-based doublets are recommended based on tumor histology
Non-SCC	Platinum-based doublet Cisplatin/pemetrexed doublet has demonstrated more efficacy and less toxicity compared to cisplatin/gemcitabine Bevacizumab added to a platinum doublet if there are no contraindications. Bevacizumab must continue to be administered until disease progression or toxicity
SCC	Platinum-based doublet
Elderly	Elderly fit patients with PS 0-1 should be treated with platinum combination chemotherapy according to histology
PS 0-2	Patients with important comorbidities or PS2 are suitable for being treated with monotherapy regimen
Maintenance	For PS 0-1, non-SCC patients with stable disease or response after four cycles Pemetrexed or erlotinib can be used as switch maintenance Pemetrexed is also indicated in continuation maintenance after four induction cycles of platinum/pemetrexed
Second line setting and beyond	For PS 0-2, docetaxel, erlotinib, or pemetrexed (only in non-SCC) Erlotinib may be recommended as third-line therapy for patients with PS of 0-2 who have not received prior EGFR TKIs
Stage IV EGFR Mut NSCLC
First-line stage IV EGFR Mut NSCLC	Gefitinib, erlotinib, afatinib
EGFR Mut patients who have not received and EGFR TKI as first line	Gefitinib, erlotinib, afatinib
EGFR Mut patients who progressed after first-line treatment with an EGFR TKI	Platinum-based chemotherapy Clinical trials with EGFR T790M TKIs* are ongoing
Stage IV ALK rearranged NSCLC
First-line ALK-rearranged stage IV NSCLC	Crizotinib
Second line ALK-rearranged naive patients	Crizotinib
Crizotinib-naive ALK-rearranged NSCLC patients who have received one prior platinum-based regimen	Crizotinib
ALK-rearranged NSCLC patients who have received previously crizotinib	Chemotherapy Ceritinib*
Other genetic alterations
Ros1	Crizotinib* (IIIC)
Met amplification	Crizotinib* (IVC)
BRAF mut	Vemurafenib*, Dabrafenib* (IVC) Dabrafenib* + Trametinib* (IIIC)
Her2 mut	Her2 monoclonal antibodies*, Her2 TKIs* (IVC)

* Not approved