Discussing the Current NCCN Guideline Recommendations and Potential Changes Following FLAURA2 Data

The panel addressed the ongoing tension betweenover clinical practice guidelines and vs emerging trial data. Despite new evidence from recent studies demonstrating a clear overall survival benefit with combination regimens, current guidelines—such as those from NCCN—still list monotherapy as the category 1 preferred option for first-line treatment. Combination regimens from the FLAURA2 and MARIPOSA studies are included, but in a lower tier. This discrepancy prompted discussion on whether the guidelines are keeping pace with the latest evidence and how that impacts real-world decision-making.

Several clinicians agreed that prior to the release of recent survival data, monotherapy’s preferred status was appropriate. However, with the clear demonstration of improved overall survival—especially gains nearing 10 to 12 months—some panelists felt the guidelines should evolve to reflect this. That said, tThey were cautious about removing monotherapy from the preferred category entirely. Many patients weigh quality of life and treatment burden heavily in their decision-making, and monotherapy remains a valid choice for those prioritizing simplicity or who may not tolerate combination therapy.

Ultimately, the group emphasized the need for flexibility in treatment recommendations. While combination regimens have shown statistically and clinically meaningful survival benefits, treatment plans must still be individualized. Rather than demoting monotherapy, there may be room to elevate combination therapies to equal footing in the guidelines. This would empower oncologists to present all viable options to patients while maintaining alignmentaligning with the latest data. As more long-term data emerges and real-world outcomes accumulate, it's likely the guidelines will be revised to reflect this evolving standard of care.