PURPOSE:To provide evidence-based recommendations for patients with stage IV non-small cell lung cancer with driver alterations. METHODS:This ASCO living guideline offers continually updated recommendations based on an ongoing systematic review of randomized controlled trials (RCTs), with the latest time frame spanning March-October 2025. An Expert Panel of medical oncology, pulmonary, community oncology, research methodology, and advocacy experts was convened. The literature search included systematic reviews, meta-analyses, and RCTs. Outcomes of interest include efficacy and safety. Expert Panel members used available evidence and informal consensus to develop evidence-based guideline recommendations. RESULTS:This guideline consolidates all previous updates and reflects the body of evidence informing this guideline topic. Thirteen studies were identified in the latest search of literature to date. RECOMMENDATIONS:Evidence-based recommendations were updated to address first, second, and subsequent treatment options for patients with driver alterations.Additional information is available at www.asco.org/thoracic-cancer-guidelines.
The Phase 1/2 Intergroup study E4412 (NCT01896999; ClinicalTrials.gov) investigated checkpoint blockade with nivolumab (Nivo) and ipilimumab (Ipi) in relapsed/refractory (R/R) classic Hodgkin lymphoma (HL) while concurrently targeting CD30+ Hodgkin Reed Sternberg cells with the antibody-drug conjugate brentuximab vedotin (BV). 147 patients ≥12 years were randomized between BV/Nivo and BV/Ipi/Nivo; 132 patients are included in primary efficacy analysis. The primary endpoint, complete response (CR) rate, was 64.7% (52.2, 75.9) for BV/Nivo and 70.3% (57.6, 81.1) for BV/Ipi/Nivo (one-sided p=0.29). The median survival follow-up is 38.0 months (interquartile range 32.6-48.1). Progression-free survival (PFS) did not significantly differ between the two arms (HR=0.78, CI 0.39-1.57, one-sided p=0.24). Treatment-related grade 3+ toxicities in the adult cohort, excluding rash, was similar between both arms (38.5% BV/Nivo and 39.3% BV/Ipi/Nivo); there was higher frequency of grade 3 rash with BV/Ipi/Nivo (24.6%) compared to BV/Nivo (9.2%). We compared PFS by stem cell transplantation (SCT) status in a planned post-hoc comparison; 58 patients received SCT; 36-month PFS (from SCT) was greater than 90% for both arms. Sixty-six patients were alive and progression free after the first scan (disease evaluation) and did not undergo SCT. The 36-month PFS (from first scan) was 73.0% (54.5, 85.0) for BV/Ipi/Nivo compared to 45.8% (26.3, 63.4) for BV/Nivo (HR=0.45, CI 0.19-1.08, one-sided p=0.03). The study did not meet its primary endpoint of superior CR rate for the triplet, but it supports the use of checkpoint-ADC induction prior to auto SCT, and there is an intriguing signal of disease control for patients wishing to defer or avoid SCT for the triplet of BV/Ipi/Nivo.
PURPOSE:Studies have identified differences by patient characteristics in addiction treatment utilization in the early COVID-19 pandemic period, yet an understanding of longitudinal changes in utilization patterns remains unclear. We examined treatment utilization trends over three years post-pandemic, with a particular focus on differences by age and race and ethnicity. METHODS:Using electronic health record data, this retrospective cohort study examined overall and telehealth addiction treatment initiation and engagement 3 years pre- and 3 years post-pandemic (3/16/2020) following identification of 170,618 episodes involving problematic substance use among 124,413 adults in a large, integrated Northern California health system. Interrupted time series models were fit to examine annual utilization rates during pre- and post-pandemic periods (3/1/2017-1/15/2020 and 5/17/2020-2/28/2023, respectively), and level- and trend-changes in utilization from pre- to post-pandemic, overall and by age group and race and ethnicity. RESULTS:Overall treatment initiation decreased from 27.0% to 24.2% during the pre-pandemic period by approximately 2% annually (RR [95% CI] = 0.98 [0.96, 0.99]), increased by 6% after the onset of the pandemic (1.06 [1.03, 1.10]), and then decreased by 2% annually in the post-pandemic period to 23.0% (0.98 [0.79, 0.99]). Telehealth initiation increased from 1.9% to 2.6% during the pre-pandemic period by 12% annually (RR [95% CI] = 1.12 [1.06, 1.19]), increased five-fold immediately after pandemic onset (RR [95% CI] = 5.14 [4.62, 5.72]), and then decreased by 10% annually (RR [95% CI] = 0.90 [0.88, 0.92]). Overall and telehealth engagement followed similar patterns. Pre- to post-pandemic trends in utilization varied by age group and slightly by race and ethnicity, which may have been primarily driven by initial increases in utilization at the onset of the pandemic. CONCLUSIONS:Following immediate increases in treatment initiation and engagement during the pandemic, utilization via telehealth decreased slightly over time. Availability of telehealth was not associated with increased or sustained utilization over time. Despite some variation in trends over time by age group and race and ethnicity, we did not find strong evidence of differences across groups.
Frontline nurse leaders are pivotal in advancing safety, quality, and engagement, yet many transition into leadership roles with limited preparation and structured support. To address this gap, Kaiser Permanente Northern California established the Assistant Nurse Manager (ANM) Community of Practice (CoP) in 2019, a Caring Science-based leadership development model uniting more than 800 ANMs across 21 medical centers. Guided by Jean Watson's Theory of Human Caring, the CoP integrates leadership formation, wellness practices, and professional development through monthly sessions featuring centering rituals, reflective dialogue, and mentorship. Over 5 years, the ANM CoP has evolved into a regionwide movement that strengthens relational leadership, psychological safety, and collective resilience. Leadership micropractices such as HeartMath for self-regulation, equine-assisted leadership for relational awareness, and mindfulness for presence translate Caring Science from theory into practice. Evaluation demonstrates a 26% improvement in first-year retention (23.5%-17.3%) and a 50% reduction in turnover within 2 years. Qualitative findings highlight increased moral resilience, belonging, and trust. Now entering its sixth year, the ANM CoP represents a replicable model for cultivating psychologically safe, caring, and high-performing leadership cultures that bridge evidence and empathy, advancing both organizational outcomes and human flourishing.
IntroductionLate hospice referral rates are on the rise and are associated with negative outcomes at the end of life (EoL). Rates of late hospice referral vary drastically from oncologist to oncologist, and behavioral and psychological factors among individual oncologists have been identified as potential contributors to this variability. However, there remains a lack of clarity about how these oncologist-specific factors affect hospice referral practices among oncologists.MethodsThe Communication Optimization and Methodology For Improving Oncologist Hospice Referral Timing (COMFORT) study explored oncologists' perspectives on facilitators of and barriers to timely hospice referral. Semi-structured, qualitative interviews were conducted with 26 practicing oncologists within a large, integrated healthcare system from 6/1/2022 - 8/31/2022. Audio-recorded interviews were transcribed and analyzed using thematic analysis.ResultsMultiple themes emerged related to patient-specific factors, hospital system characteristics, oncologist knowledge of hospice care, and specialty palliative care (SPC) involvement. Commonly described barriers to timely referral included lack of adequate time with patients, challenging family dynamics, the rise of telehealth, and the finite palliative care workforce. Facilitators that were described included the presence of departmental support (nurses, social workers, hospice liaisons), and easy interdepartmental communication with SPC.ConclusionsNumerous factors independent of hospice eligibility were reported to influence hospice referral practices among oncologists. While some factors represent challenging cultural and social barriers to timely hospice referral, other system- and patient-specific barriers offer opportunities for potential interventions.
