Living with itNon-small-cell lung cancer

Back to the Non-small-cell lung cancer hub →61 questions · 6 red cards

The decisions you may face, the aids that walk through them, the warnings on record, the first sixty days and the questions to ask.

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The first 60 days →Appointment prep sheet →Side effects →Help with costs →

Decisions you may face

19 with more than one option · full decision page →

One section per setting: the options named, what each is for, the trials behind them, the recorded trade-offs and the questions to ask.

Red cards

From the labels and guidelines behind the standard of care. Your team's thresholds win.

Emergency services now
Fainting or palpitations
Fainting, near-fainting, or an irregular or racing heartbeat; several kinase inhibitors prolong the QT interval and the labels require ECG and electrolyte monitoring.
Adagrasib Alectinib Capmatinib & tepotinib Dabrafenib + trametinib Divarasib Encorafenib Lazertinib Lorlatinib Neladalkib Olomorasib Osimertinib Pralsetinib Repotrectinib Selpercatinib Sevabertinib Sotorasib Zidesamtinib Zongertinib source
Emergency services now
Hypophysitis or adrenal crisis
Persistent headache with extreme tiredness, nausea, dizziness on standing or low blood pressure. Vomiting, severe weakness or collapse is adrenal crisis.
Cemiplimab Durvalumab Ipilimumab Ivonescimab Nivolumab Pembrolizumab Tremelimumab source
Emergency services now
Skin reaction
Blisters, peeling, or sores in the mouth or eyes with a rash. Enfortumab vedotin carries a boxed warning for Stevens-Johnson syndrome and toxic epidermal necrolysis, mostly in the first cycle.
Datopotamab deruxtecan Telisotuzumab vedotin Trastuzumab deruxtecan source
Emergency services now
Bleeding or bruising
Bleeding that will not stop, black or bloody stools, or unexplained bruising when platelets are expected to be low.
Carboplatin Paclitaxel / nab-paclitaxel source
Emergency services now
Bowel perforation
Sudden severe abdominal pain, a hard or very tender abdomen, or abdominal pain with vomiting and fever. Boxed warning for gastrointestinal perforation on bevacizumab.
Ivonescimab source
Call the 24-hour line now
Interstitial lung disease or pneumonitis
Any new or worsening cough, breathlessness or fever. The label says to interrupt treatment for any suspected ILD and to permanently discontinue for grade 2 or higher.
Datopotamab deruxtecan Trastuzumab deruxtecan source

See all on the product pages:Adagrasib Alectinib Capmatinib & tepotinib Carboplatin Cemiplimab Dabrafenib + trametinib Datopotamab deruxtecan Divarasib Durvalumab Encorafenib Ipilimumab Ivonescimab Lazertinib Lorlatinib Neladalkib Nivolumab Olomorasib Osimertinib Paclitaxel / nab-paclitaxel Pembrolizumab Pralsetinib Repotrectinib Selpercatinib Sevabertinib Sotorasib Telisotuzumab vedotin Trastuzumab deruxtecan Tremelimumab Zidesamtinib Zongertinib·Printable cards in the navigator

Treatment journeys

What the next twelve months look like, phase by phase, with the decision points.

Stage II-IIIA (resectable)

Questions to ask

Bring to your appointment

Questions to ask your oncologist about Non-small-cell lung cancer

Generated from this cancer's standard of care, biomarkers, and pipeline · 61 questions

Newly diagnosed

What is my exact diagnosis, stage, and grade, and which tests established them?
Why: Everything else follows from an accurate stage and subtype.
Which biomarkers have been tested on my tumour (for example EGFR, ALK, ROS1, BRAF V600E, MET ex14 / amplification / c-MET IHC), and what were the results?
Why: These results decide eligibility for targeted therapy, immunotherapy, and trials.
Which subtype is my cancer, and does that change the recommended treatment?
Why: Recognised subtypes for this cancer include Adenocarcinoma, Squamous, EGFR-mutant.
Is germline (inherited) genetic testing recommended for me or my family?
Why: Inherited variants can change treatment and matter for relatives.

Screening

For my situation (screening), which of the standard options do you recommend and why?
Why: Guideline options include: Annual low-dose CT for high-risk smokers (NLST, NELSON); AI nodule scoring emerging.

Early stage

For my situation (early stage), which of the standard options do you recommend and why?
Why: Guideline options include: Surgery or SBRT; perioperative chemo-immunotherapy; adjuvant osimertinib (EGFR) or alectinib (ALK).
Am I a candidate for Osimertinib, and what side effects should I expect?
Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
How do the results of ADAURA apply to someone like me?
Why: Trial populations differ from individual patients; ask how closely you match.

Stage III unresectable

For my situation (stage iii unresectable), which of the standard options do you recommend and why?
Why: Guideline options include: Chemoradiation → durvalumab (PACIFIC) or osimertinib (LAURA, EGFR).
Am I a candidate for Durvalumab, and what side effects should I expect?
Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
For my situation (stage iii unresectable), which of the standard options do you recommend and why?
Why: Guideline options include: Concurrent platinum chemoradiation → durvalumab 1 year (PACIFIC), or osimertinib until progression if EGFR-mutant (LAURA). Proton therapy in selected cases.
Am I a candidate for Durvalumab, Osimertinib, and what side effects should I expect?
Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
How do the results of PACIFIC and LAURA apply to someone like me?
Why: Trial populations differ from individual patients; ask how closely you match.

Metastatic, driver-positive

For my situation (metastatic, driver-positive), which of the standard options do you recommend and why?
Why: Guideline options include: Matched TKI or bispecific; ADCs after progression.
Am I a candidate for Osimertinib, Amivantamab, Lorlatinib or related drugs, and what side effects should I expect?
Why: Knowing the expected toxicities helps you plan work, family, and supportive care.

Metastatic, driver-negative

For my situation (metastatic, driver-negative), which of the standard options do you recommend and why?
Why: Guideline options include: PD-(L)1 ± chemotherapy; docetaxel or ADC/TTFields second line.
Am I a candidate for Pembrolizumab, Nivolumab, Optune / Optune Pax (TTFields), and what side effects should I expect?
Why: Knowing the expected toxicities helps you plan work, family, and supportive care.

Screening (age 50-80, ≥20 pack-years)

For my situation (screening (age 50-80, ≥20 pack-years)), which of the standard options do you recommend and why?
Why: Guideline options include: Annual low-dose CT with Lung-RADS reporting; AI nodule scoring emerging; robotic bronchoscopy for peripheral nodule biopsy.
How do the results of NLST & NELSON (low-dose CT screening) apply to someone like me?
Why: Trial populations differ from individual patients; ask how closely you match.

Stage I-II resectable

For my situation (stage i-ii resectable), which of the standard options do you recommend and why?
Why: Guideline options include: Lobectomy or segmentectomy (small peripheral) with nodal staging; SBRT if inoperable. Stage IB-IIIA: neoadjuvant chemo-IO (CheckMate 816) or perioperative chemo-IO (KEYNOTE-671); adjuvant osimertinib if EGFR-mutant (ADAURA), alectinib if ALK-positive (ALINA); adjuvant chemotherapy otherwise for stage II+.
Am I a candidate for Osimertinib, Alectinib, and what side effects should I expect?
Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
How do the results of CheckMate 816 and KEYNOTE-671 apply to someone like me?
Why: Trial populations differ from individual patients; ask how closely you match.

Metastatic, EGFR exon 19 del / L858R

For my situation (metastatic, egfr exon 19 del / l858r), which of the standard options do you recommend and why?
Why: Guideline options include: First line: osimertinib ± platinum-pemetrexed (FLAURA2) or amivantamab + lazertinib (MARIPOSA, OS benefit). Progression: re-biopsy/ctDNA; amivantamab + chemotherapy (MARIPOSA-2), Dato-DXd (TROPION-Lung05), platinum doublet; MET TKI add-on if MET-amplified; platinum-etoposide if small-cell transformation.
Am I a candidate for Osimertinib, Amivantamab, Lazertinib or related drugs, and what side effects should I expect?
Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
How do the results of FLAURA2 and MARIPOSA apply to someone like me?
Why: Trial populations differ from individual patients; ask how closely you match.

Metastatic, EGFR exon 20 insertion

For my situation (metastatic, egfr exon 20 insertion), which of the standard options do you recommend and why?
Why: Guideline options include: Amivantamab + platinum-pemetrexed (PAPILLON); sunvozertinib later line.
Am I a candidate for Amivantamab, and what side effects should I expect?
Why: Knowing the expected toxicities helps you plan work, family, and supportive care.

Metastatic, ALK-rearranged

For my situation (metastatic, alk-rearranged), which of the standard options do you recommend and why?
Why: Guideline options include: Lorlatinib (CROWN; 5-year PFS 60%) or alectinib first line; on progression, neladalkib (under review) or lorlatinib if not used; local therapy for oligoprogression; chemotherapy.
Am I a candidate for Lorlatinib, Alectinib, Neladalkib, and what side effects should I expect?
Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
How do the results of CROWN and ALKOVE-1 apply to someone like me?
Why: Trial populations differ from individual patients; ask how closely you match.

Metastatic, ROS1-rearranged

For my situation (metastatic, ros1-rearranged), which of the standard options do you recommend and why?
Why: Guideline options include: Repotrectinib or zidesamtinib (2026) first line; entrectinib/crizotinib alternatives.
Am I a candidate for Repotrectinib, Zidesamtinib, and what side effects should I expect?
Why: Knowing the expected toxicities helps you plan work, family, and supportive care.

Metastatic, KRAS G12C

For my situation (metastatic, kras g12c), which of the standard options do you recommend and why?
Why: Guideline options include: First line: PD-(L)1 ± chemotherapy by PD-L1 (G12C inhibitor + IO combinations in phase 3: olomorasib SUNRAY-01, divarasib Krascendo 2). Second line: sotorasib or adagrasib (CodeBreaK 200, KRYSTAL-12); divarasib superior head-to-head (Krascendo 1, 2026).
Am I a candidate for Sotorasib, Adagrasib, Divarasib or related drugs, and what side effects should I expect?
Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
How do the results of CodeBreaK 200 and KRYSTAL-12 apply to someone like me?
Why: Trial populations differ from individual patients; ask how closely you match.

Metastatic, BRAF V600E

For my situation (metastatic, braf v600e), which of the standard options do you recommend and why?
Why: Guideline options include: Dabrafenib + trametinib or encorafenib + binimetinib first line; chemo-IO as alternative.
Am I a candidate for Dabrafenib + trametinib, Encorafenib, and what side effects should I expect?
Why: Knowing the expected toxicities helps you plan work, family, and supportive care.

Metastatic, MET exon 14 skipping

For my situation (metastatic, met exon 14 skipping), which of the standard options do you recommend and why?
Why: Guideline options include: Capmatinib or tepotinib first line; telisotuzumab vedotin for c-Met-overexpressing EGFR-wild-type disease after chemotherapy (accelerated 2025).
Am I a candidate for Capmatinib & tepotinib, Telisotuzumab vedotin, and what side effects should I expect?
Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
How do the results of TeliMET NSCLC-01 apply to someone like me?
Why: Trial populations differ from individual patients; ask how closely you match.

Metastatic, RET-fusion

For my situation (metastatic, ret-fusion), which of the standard options do you recommend and why?
Why: Guideline options include: Selpercatinib first line (LIBRETTO-431); pralsetinib alternative.
Am I a candidate for Selpercatinib, Pralsetinib, and what side effects should I expect?
Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
How do the results of LIBRETTO-431 apply to someone like me?
Why: Trial populations differ from individual patients; ask how closely you match.

Metastatic, HER2-mutant

For my situation (metastatic, her2-mutant), which of the standard options do you recommend and why?
Why: Guideline options include: First line: zongertinib (2026) or chemo-IO; sevabertinib (Nov 2025) or T-DXd after prior therapy.
Am I a candidate for Zongertinib, Sevabertinib, Trastuzumab deruxtecan, and what side effects should I expect?
Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
How do the results of SOHO-01 apply to someone like me?
Why: Trial populations differ from individual patients; ask how closely you match.

Metastatic, NTRK-fusion

For my situation (metastatic, ntrk-fusion), which of the standard options do you recommend and why?
Why: Guideline options include: Larotrectinib, entrectinib, or repotrectinib (tumour-agnostic).
Am I a candidate for Repotrectinib, and what side effects should I expect?
Why: Knowing the expected toxicities helps you plan work, family, and supportive care.

Metastatic, driver-negative, PD-L1 TPS ≥50%

For my situation (metastatic, driver-negative, pd-l1 tps ≥50%), which of the standard options do you recommend and why?
Why: Guideline options include: Pembrolizumab (KEYNOTE-024) or cemiplimab monotherapy; add chemotherapy for high burden or rapid progression. Ivonescimab beat pembrolizumab in China (HARMONi-2); not approved in the US.
Am I a candidate for Pembrolizumab, Cemiplimab, Ivonescimab, and what side effects should I expect?
Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
How do the results of KEYNOTE-024 & KEYNOTE-189 and HARMONi-2 apply to someone like me?
Why: Trial populations differ from individual patients; ask how closely you match.

Metastatic, driver-negative, PD-L1 TPS <50%

For my situation (metastatic, driver-negative, pd-l1 tps <50%), which of the standard options do you recommend and why?
Why: Guideline options include: Pembrolizumab + platinum doublet (KEYNOTE-189 non-squamous; KEYNOTE-407 squamous); nivolumab + ipilimumab ± chemotherapy; tremelimumab + durvalumab + chemotherapy for PD-L1-negative or STK11/KEAP1-altered disease. Second line: docetaxel ± ramucirumab, TTFields, or trials of ADCs.
Am I a candidate for Pembrolizumab, Nivolumab, Ipilimumab or related drugs, and what side effects should I expect?
Why: Knowing the expected toxicities helps you plan work, family, and supportive care.

Metastatic, squamous

For my situation (metastatic, squamous), which of the standard options do you recommend and why?
Why: Guideline options include: Pembrolizumab + carboplatin + (nab-)paclitaxel (KEYNOTE-407); no ADC approved (TROPION-Lung01 showed no benefit in squamous); ivonescimab + chemotherapy under study (HARMONi-3).
Am I a candidate for Pembrolizumab, Paclitaxel / nab-paclitaxel, Carboplatin, and what side effects should I expect?
Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
How do the results of TROPION-Lung01 and HARMONi-3 apply to someone like me?
Why: Trial populations differ from individual patients; ask how closely you match.

Any stage

Are there clinical trials I could join, for example of Ivonescimab, Izalontamab brengitecan, Sacituzumab tirumotecan, Tilatamig samrotecan?
Why: Trials are how the next standard of care is set; asking early keeps options open.
Would a second opinion at a high-volume centre change anything, and can you help arrange it?
Why: Rare or high-stakes decisions benefit from a centre that treats many similar patients.
What supportive care (symptom control, nutrition, exercise, mental health, financial help) is available from the start?
Why: Supportive care improves quality of life and helps patients complete treatment.
I read that “Resistance to every TKI”. How does that affect my plan?
Why: Open problems are where trials and second opinions matter most.
I read that “Squamous histology has few targets”. How does that affect my plan?
Why: Open problems are where trials and second opinions matter most.

Newly diagnosed? Read the first 60 days with Non-small-cell lung cancer, then print the one-page appointment sheet with room for the answers.

Print this page for your appointment (your browser's print command). These prompts are for discussion; your clinical team knows your case.

Model panel1 model

Machine commentary by named AI models on a date, not clinical review. Claims are tied to the record's own sources; check them before relying on anything here.

FableAnthropic · v5.12026-09-17low confidence

The epidemiology and histology framing (NSCLC as about 85% of lung cancer, tobacco driving squamous and KRAS-mutant disease, never-smoker adenocarcinoma enriched for EGFR) is consistent with the cited Wikipedia article, and the stage-by-stage treatment structure matches how NCCN organises the disease. The bulk of the record's most specific content, however, is a dense sequence of 2025-2026 approvals, PDUFA dates and head-to-head trial outcomes that none of the three listed sources can confirm: the NCCN guideline is login-gated, and the third source is a PubMed Central article mislabelled as the NCCN guideline with an ESMO-MCBS score attached. The record also omits TNM staging and survival by stage, and carries many duplicated rows across subtypes, biomarkers, standard of care and history that should be merged. Nothing here is a clinical review and no treatment advice is implied.

Right 2Disputed 1Missing 1Unclear 4Show verdicts

Right
Non-small-cell lung cancer is ~85% of lung cancer; adenocarcinoma and squamous cell carcinoma dominate, with large-cell and other histologies making up the rest.
The Wikipedia article gives NSCLC as roughly 85% of lung cancers and names adenocarcinoma, squamous cell and large-cell carcinoma as the main histologies. The record's adenocarcinoma share (~50%) is higher than the figure commonly quoted on that page, so the exact split should be treated as approximate.
Wikipedia
Right
Tobacco drives most squamous and KRAS-mutant disease; never-smoker adenocarcinoma is EGFR- and ALK-enriched.
The Wikipedia article links squamous cell carcinoma closely with smoking and describes adenocarcinoma as the histology most often seen in never-smokers, with EGFR mutations concentrated in that group. The ALK enrichment is consistent with the linked target record but is not detailed in the cited page.
Wikipedia
Unclear
HARMONi-3 missed its interim PFS analysis in May 2026, with an FDA decision on ivonescimab due 14 November 2026; neladalkib PDUFA 27 November 2026; zidesamtinib approved July 2026; divarasib superior in Krascendo 1 in 2026.
None of the three listed sources is a regulatory or trial-results source, and the NCCN page requires a login, so these dated regulatory and trial statements cannot be checked from the record's own citations. They rest on linked drug and trial records rather than on a cited primary source.
NCCN Guidelines: Non-Small Cell Lung Cancer (Screening)
Unclear
Metastatic, driver-positive: matched TKI or bispecific; ADCs after progression (guideline: NCCN Guidelines, url PMC11163648, ESMO-MCBS 3 for DESTINY-Lung02).
The guideline field is labelled as the NCCN guideline but points to a PubMed Central article rather than the NCCN guideline page used for the other settings, and it attaches an ESMO-MCBS score for a HER2 trial to an NCCN label. The record should say what the PMC article is and separate the ESMO scoring from the NCCN citation.
NCCN Guidelines: Non-Small Cell Lung Cancer (Metastatic, driver-positive)
Unclear
Lorlatinib: 5-year PFS 60% in ALK-positive disease, the longest for any targeted therapy in metastatic solid tumours.
The 60% five-year figure matches the linked CROWN trial record, but the superlative that it is the longest for any targeted therapy in any metastatic solid tumour is a cross-tumour comparison that none of the listed sources addresses.
Wikipedia
Unclear
Screening uptake is under 20% in the US and lower elsewhere.
The NCCN screening guideline sets eligibility (the record's age 50-80 and 20 pack-year criteria are consistent with current US practice) but is not a source for uptake statistics, and it is behind a login. No cited source gives the uptake figure.
NCCN Guidelines: Non-Small Cell Lung Cancer (Screening)
Missing
Staging (TNM stage groups) and survival by stage at diagnosis.
The record organises care by stage but never states what the stages are or gives stage-specific survival, which the Wikipedia article covers. A cancer record for a disease whose whole narrative is 'found late' should quantify what late means.
Wikipedia
Disputed
The record contains duplicated entries in subtypes, biomarkers, standardOfCare (two Screening and two Stage III unresectable rows) and history (2004, 2007, 2011, 2015, 2021, 2025 each appear twice).
This is an internal consistency problem rather than a factual one: the duplicates carry slightly different wording and refs, so a reader cannot tell which version is authoritative. Merging them would not change the medicine but would make the record checkable.
Wikipedia

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ProvenanceLast edited 2026-09-18 · Jude Gomila · Link cancer subtypes to their siblings and name parents i… · diff · file · history

Wikipedia

Non-small-cell lung cancer

Sources & links

Wikipedia