Non-small cell lung cancer: did the treatment follow the guidelines?

Non-small cell lung cancer (NSCLC) makes up about 85 percent of lung cancers, and its modern treatment hinges on molecular testing. The clinical practice guidelines are blunt about the order of operations: establish the stage, test the tumor, then choose therapy based on what the tests show.

The decisions that matter

• Staging. Treatment splits sharply by stage, so the record needs to establish it. Early disease is about surgery or radiation. Advanced disease is about systemic therapy, and everything below applies.
• Molecular testing before treatment. Advanced NSCLC should be tested for driver mutations, including EGFR, ALK, and ROS1, along with the PD-L1 level, before first-line therapy starts. The result decides the whole plan, which is why starting treatment without it is the classic NSCLC deviation.
• Matched first-line therapy. A driver mutation means a matched targeted drug first, such as osimertinib for EGFR or alectinib for ALK, not chemotherapy. These drugs work dramatically better in the patients they fit than chemotherapy does, and the guidelines put them first for good reason. With no driver mutation, the PD-L1 level steers the choice among immunotherapy and chemotherapy combinations.

What a deviation looks like

A metastatic lung adenocarcinoma started on chemotherapy in the same week it was diagnosed, with no molecular panel ever sent. An EGFR result sitting positive in the chart while the patient stays on chemotherapy. These are the patterns this check is built to surface, and every finding cites the guideline page it rests on.