Japanese Lung Cancer Society Guidelines for Stage IV NSCLC With EGFR Mutations

Kiichiro Ninomiya, Shunsuke Teraoka, Yoshitaka Zenke, Hirotsugu Kenmotsu, Yukiko Nakamura, Yusuke Okuma, Akihiro Tamiya, Kaname Nosaki, Masahiro Morise, Keiju Aokage, Yuko Oya, Toshiyuki Kozuki, Tomohiro Sakamoto, Kentaro Tanaka, Hisashi Tanaka, Junko Tanizaki, Satoru Miura, Hideaki Mizutani, Eisaku Miyauchi, Ou YamaguchiNoriyuki Ebi, Yasushi Goto, Takaaki Sasaki, Haruko Daga, Satoshi Morita, Takeharu Yamanaka, Shinsuke Amano, Kazuo Hasegawa, Chiyo K. Imamura, Kenichi Suzuki, Kazuko Nakajima, Hitomi Nishimoto, Satoshi Oizumi, Toyoaki Hida, Katsuyuki Hotta, Yuichi Takiguchi

Research output: Contribution to journalReview articlepeer-review

18 Citations (Scopus)


Patients with NSCLC in East Asia, including Japan, frequently contain EGFR mutations. In 2018, we published the latest full clinical practice guidelines on the basis of those provided by the Japanese Lung Cancer Society Guidelines Committee. The purpose of this study was to update those recommendations, especially for the treatment of metastatic or recurrent EGFR-mutated NSCLC. We conducted a literature search of systematic reviews of randomized controlled and nonrandomized trials published between 2018 and 2019 that multiple physicians had reviewed independently. On the basis of those studies and the advice from the Japanese Society of Lung Cancer Expert Panel, we developed updated guidelines according to the Grading of Recommendations, Assessment, Development, and Evaluation system. We also evaluated the benefits of overall and progression-free survival, end points, toxicities, and patients’ reported outcomes. For patients with NSCLC harboring EGFR-activating mutations, the use of EGFR tyrosine kinase inhibitors (EGFR TKIs), especially osimertinib, had the best recommendation as to first-line treatment. We also recommended the combination of EGFR TKI with other agents (platinum-based chemotherapy or antiangiogenic agents); however, it can lead to toxicity. In the presence of EGFR uncommon mutations, except for an exon 20 insertion, we also recommended the EGFR TKI treatment. However, we could not provide recommendations for the treatment of EGFR mutations with immune checkpoint inhibitors, including monotherapy, and its combination with cytotoxic chemotherapy, because of the limited evidence present in the literature. The 2020 Japanese Lung Cancer Society Guidelines can help community-based physicians to determine the most appropriate treatments and adequately provide medical care to their patients.

Original languageEnglish
Article number100107
JournalJTO Clinical and Research Reports
Issue number1
Publication statusPublished - Jan 2021

All Science Journal Classification (ASJC) codes

  • Oncology
  • Pulmonary and Respiratory Medicine


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