Appointment sheet
Non-small-cell lung cancer
Prepared with OnCo (onco.cc/prep/nsclc/). Orientation, not medical advice; your team knows your case.
My details
Name
Date of appointment
Hospital and clinician
Who is coming with me
What I know, what is unclear, changes to discuss
Saved in this browserWhat I know so far
What is unclear to me
Changes since last time
My questions
61 on the sheetNewly diagnosed
- 1.What is my exact diagnosis, stage, and grade, and which tests established them?
- 2.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?
- 3.Which subtype is my cancer, and does that change the recommended treatment?
- 4.Is germline (inherited) genetic testing recommended for me or my family?
Screening
- 5.For my situation (screening), which of the standard options do you recommend and why?
Early stage
- 6.For my situation (early stage), which of the standard options do you recommend and why?
- 7.Am I a candidate for Osimertinib, and what side effects should I expect?
- 8.How do the results of ADAURA apply to someone like me?
Stage III unresectable
- 9.For my situation (stage iii unresectable), which of the standard options do you recommend and why?
- 10.Am I a candidate for Durvalumab, and what side effects should I expect?
- 20.For my situation (stage iii unresectable), which of the standard options do you recommend and why?
- 21.Am I a candidate for Durvalumab, Osimertinib, and what side effects should I expect?
- 22.How do the results of PACIFIC and LAURA apply to someone like me?
Metastatic, driver-positive
- 11.For my situation (metastatic, driver-positive), which of the standard options do you recommend and why?
- 12.Am I a candidate for Osimertinib, Amivantamab, Lorlatinib or related drugs, and what side effects should I expect?
Metastatic, driver-negative
- 13.For my situation (metastatic, driver-negative), which of the standard options do you recommend and why?
- 14.Am I a candidate for Pembrolizumab, Nivolumab, Optune / Optune Pax (TTFields), and what side effects should I expect?
Screening (age 50-80, ≥20 pack-years)
- 15.For my situation (screening (age 50-80, ≥20 pack-years)), which of the standard options do you recommend and why?
- 16.How do the results of NLST & NELSON (low-dose CT screening) apply to someone like me?
Stage I-II resectable
- 17.For my situation (stage i-ii resectable), which of the standard options do you recommend and why?
- 18.Am I a candidate for Osimertinib, Alectinib, and what side effects should I expect?
- 19.How do the results of CheckMate 816 and KEYNOTE-671 apply to someone like me?
Metastatic, EGFR exon 19 del / L858R
- 23.For my situation (metastatic, egfr exon 19 del / l858r), which of the standard options do you recommend and why?
- 24.Am I a candidate for Osimertinib, Amivantamab, Lazertinib or related drugs, and what side effects should I expect?
- 25.How do the results of FLAURA2 and MARIPOSA apply to someone like me?
Metastatic, EGFR exon 20 insertion
- 26.For my situation (metastatic, egfr exon 20 insertion), which of the standard options do you recommend and why?
- 27.Am I a candidate for Amivantamab, and what side effects should I expect?
Metastatic, ALK-rearranged
- 28.For my situation (metastatic, alk-rearranged), which of the standard options do you recommend and why?
- 29.Am I a candidate for Lorlatinib, Alectinib, Neladalkib, and what side effects should I expect?
- 30.How do the results of CROWN and ALKOVE-1 apply to someone like me?
Metastatic, ROS1-rearranged
- 31.For my situation (metastatic, ros1-rearranged), which of the standard options do you recommend and why?
- 32.Am I a candidate for Repotrectinib, Zidesamtinib, and what side effects should I expect?
Metastatic, KRAS G12C
- 33.For my situation (metastatic, kras g12c), which of the standard options do you recommend and why?
- 34.Am I a candidate for Sotorasib, Adagrasib, Divarasib or related drugs, and what side effects should I expect?
- 35.How do the results of CodeBreaK 200 and KRYSTAL-12 apply to someone like me?
Metastatic, BRAF V600E
- 36.For my situation (metastatic, braf v600e), which of the standard options do you recommend and why?
- 37.Am I a candidate for Dabrafenib + trametinib, Encorafenib, and what side effects should I expect?
Metastatic, MET exon 14 skipping
- 38.For my situation (metastatic, met exon 14 skipping), which of the standard options do you recommend and why?
- 39.Am I a candidate for Capmatinib & tepotinib, Telisotuzumab vedotin, and what side effects should I expect?
- 40.How do the results of TeliMET NSCLC-01 apply to someone like me?
Metastatic, RET-fusion
- 41.For my situation (metastatic, ret-fusion), which of the standard options do you recommend and why?
- 42.Am I a candidate for Selpercatinib, Pralsetinib, and what side effects should I expect?
- 43.How do the results of LIBRETTO-431 apply to someone like me?
Metastatic, HER2-mutant
- 44.For my situation (metastatic, her2-mutant), which of the standard options do you recommend and why?
- 45.Am I a candidate for Zongertinib, Sevabertinib, Trastuzumab deruxtecan, and what side effects should I expect?
- 46.How do the results of SOHO-01 apply to someone like me?
Metastatic, NTRK-fusion
- 47.For my situation (metastatic, ntrk-fusion), which of the standard options do you recommend and why?
- 48.Am I a candidate for Repotrectinib, and what side effects should I expect?
Metastatic, driver-negative, PD-L1 TPS ≥50%
- 49.For my situation (metastatic, driver-negative, pd-l1 tps ≥50%), which of the standard options do you recommend and why?
- 50.Am I a candidate for Pembrolizumab, Cemiplimab, Ivonescimab, and what side effects should I expect?
- 51.How do the results of KEYNOTE-024 & KEYNOTE-189 and HARMONi-2 apply to someone like me?
Metastatic, driver-negative, PD-L1 TPS <50%
- 52.For my situation (metastatic, driver-negative, pd-l1 tps <50%), which of the standard options do you recommend and why?
- 53.Am I a candidate for Pembrolizumab, Nivolumab, Ipilimumab or related drugs, and what side effects should I expect?
Metastatic, squamous
- 54.For my situation (metastatic, squamous), which of the standard options do you recommend and why?
- 55.Am I a candidate for Pembrolizumab, Paclitaxel / nab-paclitaxel, Carboplatin, and what side effects should I expect?
- 56.How do the results of TROPION-Lung01 and HARMONi-3 apply to someone like me?
Any stage
- 57.Are there clinical trials I could join, for example of Ivonescimab, Izalontamab brengitecan, Sacituzumab tirumotecan, Tilatamig samrotecan?
- 58.Would a second opinion at a high-volume centre change anything, and can you help arrange it?
- 59.What supportive care (symptom control, nutrition, exercise, mental health, financial help) is available from the start?
- 60.I read that “Resistance to every TKI”. How does that affect my plan?
- 61.I read that “Squamous histology has few targets”. How does that affect my plan?
The words I may hear
- Histology: The study of tissue under the microscope.
- EGFR mutation subtypes (exon 19 deletion, L858R, exon 20 insertion, T790M): Lung cancers with a mutated EGFR gene are treated with EGFR pills, but which pill and how well it works depends on exactly where the mutation is.
- Tumour proportion score (TPS): The PD-L1 score used in lung cancer: the percentage of tumour cells that stain positive.
- EGFR exon 19 deletion & L858R: Exon 19 deletion and L858R are the two common EGFR mutations, together ~85% of EGFR-mutant lung cancer, and both respond to EGFR pills.
- MET amplification (bypass resistance): When lung cancer switches on the MET receptor to bypass a blocked EGFR pill.
- EGFR C797S: A mutation that stops osimertinib from binding to EGFR; the main on-target way lung cancers escape it.
- Lobectomy: Removing one lobe of the lung (the right lung has three, the left two).
- EGFR exon 20 insertion: A rarer EGFR mutation (~2% of lung cancers) that does not respond to standard EGFR pills and needs its own drugs.
- Oligoprogression: When only one or two spots grow on an otherwise working targeted therapy; treat the spots and keep the pill.
- STK11 / KEAP1 co-mutations: Two genes whose loss, often alongside a KRAS mutation, makes lung cancer 'cold' to immunotherapy and shortens survival on standard treatment.
Tests and results to bring
Biomarker results to ask for: EGFR, ALK, ROS1, BRAF V600E, MET ex14 / amplification / c-MET IHC, RET, NTRK, KRAS G12C, HER2 mutation, PD-L1 TPS, ctDNA, PD-L1 TPS (22C3), EGFR (exon 19 del, L858R, exon 20 ins, T790M, C797S), ALK fusion, ROS1 fusion, KRAS G12C (and G12D/V), MET exon 14 skipping, MET amplification, c-Met IHC, RET fusion, HER2 (ERBB2) mutation, NTRK fusion, STK11 / KEAP1 (prognostic, IO resistance), TP53 / RB1 (transformation risk), ctDNA (genotyping, MRD, resistance tracking), TMB (limited use).
Scans and tests linked to this cancer: Companion diagnostics, Comprehensive genomic profiling, CT (computed tomography), Endoscopic ultrasound and EBUS systems, Histopathology & immunohistochemistry, In-room imaging for radiotherapy (cone-beam CT, ExacTrac, CT-on-rails, HyperSight).
Bring copies of scan reports, pathology and blood results, and a list of every medicine and supplement.
The treatments I may be offered
- Screening: Annual low-dose CT for high-risk smokers (NLST, NELSON); AI nodule scoring emerging. (CT (computed tomography), AI in radiology)
- Screening (age 50-80, ≥20 pack-years): Annual low-dose CT with Lung-RADS reporting; AI nodule scoring emerging; robotic bronchoscopy for peripheral nodule biopsy. (Low-dose CT lung screening, NLST & NELSON (low-dose CT screening), Robotic and navigational bronchoscopy, AI in radiology)
- Early stage: Surgery or SBRT; perioperative chemo-immunotherapy; adjuvant osimertinib (EGFR) or alectinib (ALK). (SBRT / SABR (stereotactic radiotherapy), ADAURA, Osimertinib)
- Stage I-II resectable: 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+. (Robotic & minimally invasive surgery, SBRT / SABR (stereotactic radiotherapy), CheckMate 816, KEYNOTE-671, ADAURA, ALINA, Osimertinib, Alectinib)
- Stage III unresectable: Chemoradiation → durvalumab (PACIFIC) or osimertinib (LAURA, EGFR). (Durvalumab, IMRT / IGRT (modern external beam))
- Stage III unresectable: Concurrent platinum chemoradiation → durvalumab 1 year (PACIFIC), or osimertinib until progression if EGFR-mutant (LAURA). Proton therapy in selected cases. (IMRT / IGRT (modern external beam), PACIFIC, LAURA, Durvalumab, Osimertinib, Proton therapy)
- Metastatic, driver-positive: Matched TKI or bispecific; ADCs after progression. (Osimertinib, Amivantamab, Lorlatinib, Selpercatinib, Zongertinib, Sotorasib, Datopotamab deruxtecan)
- Metastatic, driver-negative: PD-(L)1 ± chemotherapy; docetaxel or ADC/TTFields second line. (Pembrolizumab, Nivolumab, Optune / Optune Pax (TTFields))
- Metastatic, EGFR exon 19 del / L858R: 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. (Osimertinib, FLAURA2, Amivantamab, Lazertinib, MARIPOSA, Amivantamab + lazertinib (first-line EGFR NSCLC), Datopotamab deruxtecan, TROPION-Lung05, EGFR exon 19 deletion & L858R, EGFR C797S, MET amplification (bypass resistance), Histologic transformation)
- Metastatic, EGFR exon 20 insertion: Amivantamab + platinum-pemetrexed (PAPILLON); sunvozertinib later line. (Amivantamab, EGFR exon 20 insertion)
- Metastatic, ALK-rearranged: 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. (Lorlatinib, CROWN, Alectinib, Neladalkib, ALKOVE-1, Oligoprogression)
- Metastatic, ROS1-rearranged: Repotrectinib or zidesamtinib (2026) first line; entrectinib/crizotinib alternatives. (Repotrectinib, Zidesamtinib, ROS1)
- Metastatic, KRAS G12C: 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). (Sotorasib, Adagrasib, Divarasib, Olomorasib, CodeBreaK 200, KRYSTAL-12, Krascendo 1, KRAS & RAS inhibitors)
- Metastatic, BRAF V600E: Dabrafenib + trametinib or encorafenib + binimetinib first line; chemo-IO as alternative. (Dabrafenib + trametinib, Encorafenib, BRAF)
- Metastatic, MET exon 14 skipping: Capmatinib or tepotinib first line; telisotuzumab vedotin for c-Met-overexpressing EGFR-wild-type disease after chemotherapy (accelerated 2025). (Capmatinib & tepotinib, Telisotuzumab vedotin, TeliMET NSCLC-01, MET)
- Metastatic, RET-fusion: Selpercatinib first line (LIBRETTO-431); pralsetinib alternative. (Selpercatinib, LIBRETTO-431, Pralsetinib, RET)
- Metastatic, HER2-mutant: First line: zongertinib (2026) or chemo-IO; sevabertinib (Nov 2025) or T-DXd after prior therapy. (Zongertinib, Sevabertinib, SOHO-01, Trastuzumab deruxtecan, HER2)
- Metastatic, NTRK-fusion: Larotrectinib, entrectinib, or repotrectinib (tumour-agnostic). (Repotrectinib, NTRK, Tumour-agnostic (tissue-agnostic) approval)
- Metastatic, driver-negative, PD-L1 TPS ≥50%: 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. (Pembrolizumab, Cemiplimab, KEYNOTE-024 & KEYNOTE-189, Ivonescimab, HARMONi-2, Tumour proportion score (TPS))
- Metastatic, driver-negative, PD-L1 TPS <50%: 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. (Pembrolizumab, Nivolumab, Ipilimumab, Tremelimumab, Durvalumab, PD-1 blockade + chemotherapy in PD-L1-low NSCLC, Optune / Optune Pax (TTFields))
- Metastatic, squamous: Pembrolizumab + carboplatin + (nab-)paclitaxel (KEYNOTE-407); no ADC approved (TROPION-Lung01 showed no benefit in squamous); ivonescimab + chemotherapy under study (HARMONi-3). (Pembrolizumab, Paclitaxel / nab-paclitaxel, Carboplatin, TROPION-Lung01, HARMONi-3)
From the standard of care recorded for this cancer; which apply depends on your stage and biomarkers. Ask which the team recommends and why.
Answers and next steps
Saved in this browserWhat I was told
Agreed next steps, dates and who to call