[Chinese expert consensus on immunotherapy for advanced non-small lung cancer with oncogenic driver mutations (2023 edition)].

Non-small cell lung cancer (NSCLC) with oncogenic driver mutations was previously deemed " forbidden territory" for immunotherapy. With the growing understanding of the impact of target drugs on the immune microenvironment and the continuous generation of clinical evidence, immunotherapy is expected to bring new hope for the NSCLC with oncogenic driver mutations. This consensus is updated based on the Chinese expert consensus on immunotherapy for advanced non-small lung cancer with oncogenic driver mutations (2022 edition), and developed by the consensus expert panel through symposiums, combining the latest medical evidence and clinical practice. After thorough discussion, the expert panel reached new consensuses on 3 clinical questions: in patients with ALK fusion who are progressing on tyrosine kinase inhibitor(TKI) therapy, immune checkpoint inhibitors (ICIs)-based treatment is not recommended; ICIs-based treatment is recommended for patients with HER-2 mutations; ICIs-based treatment is recommended for NSCLC patients with MET exon 14 skipping after resistance to the targeted therapy. At the same time, with the continuous accumulation of clinical evidence, the recommendation levels of the three consensus opinions were adjusted in this update: the recommendation of ICIs combined with anti-angiogenesis therapy for patients with extensive progression after EGFR-TKIs resistance was adjusted to the level of strong; the ICIs recommendations for patients with advanced KRAS mutant and BRAF mutant NSCLC were adjusted to the level of consistent and strong, respectively. This updated consensus, combined with the latest evidence and clinical experience widely recognized by the expert panel in the immunotherapy of driver gene mutation advanced NSCLC, aims to provide standardized guidance for the clinical practice in China.驱动基因阳性晚期非小细胞肺癌既往被认为是免疫治疗"禁区"，但随着对靶向药物免疫调节作用的深入认识及临床证据不断生成，免疫治疗有望为驱动基因阳性晚期非小细胞肺癌带来新希望。共识在《晚期驱动基因阳性非小细胞肺癌免疫治疗专家共识(2022版)》的基础上，由共识专家组结合最新循证医学证据和临床实践，通过共识更新研讨会共同制定。专家组经充分研讨在3个临床问题上形成新的共识，不推荐免疫检查点抑制剂(ICIs)用于治疗间变性淋巴瘤激酶酪氨酸激酶抑制剂(TKI)耐药后非小细胞肺癌患者，推荐人表皮生长因子受体2突变患者使用以ICIs为基础的治疗策略，推荐MET14外显子跳跃突变患者在靶向治疗耐药或不可及时使用以ICIs为基础的治疗策略。同时，随着临床证据的不断积累，专家组也调整了3条共识意见的推荐级别，对于表皮生长因子TKI耐药后发生广泛进展患者使用ICIs联合抗血管治疗调整为强推荐，对于晚期KRAS突变和BRAF突变非小细胞肺癌患者的ICIs治疗分别调整为一致推荐和强推荐。共识结合国内外驱动基因阳性晚期非小细胞肺癌免疫治疗的最新进展及专家组广泛认可的临床经验，旨在为中国临床医师的免疫治疗临床实践提供规范化引导。.