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onc.lung-cancer.core.v1PRODUCTION
onc.lung-cancer.core.v1

Non-small cell lung cancer (NSCLC)

oncologychronicadult
Hard-required inputs
0 / 9

Encounter flow

12/12 authored

Canonical 12-phase frame with authored status for this dossier.

Current phase

Frame

Detailed

Determine scope: LDCT screening vs nodule workup vs confirmed NSCLC staging/treatment (NCCN 2024 NSCLC)

Inputs
2
Actions
0
Advance rule
Set
Advance when

Clinical pathway identified: screening, nodule management, or confirmed NSCLC (NCCN 2024 NSCLC)

Patient inputs (11)

Baseline oxygenation; respiratory compromise assessment (NCCN 2024 NSCLC)

BSA for chemotherapy dosing (NCCN 2024 NSCLC)

Performance status drives treatment eligibility (NCCN 2024 NSCLC)

Screening eligibility (USPSTF 2021), surgical candidacy, performance status assessment (NCCN 2024 NSCLC)

LDCT screening criteria >=20 pack-years (USPSTF 2021)

Nodule characterisation, staging (TNM 8th ed)

Baseline before chemotherapy; cytopenias affect eligibility (NCCN 2024 NSCLC)

Renal function for cisplatin vs carboplatin selection (NCCN 2024 NSCLC)

Hepatic function for chemotherapy dosing and immunotherapy monitoring (NCCN 2024 NSCLC)

EGFR/ALK/ROS1/BRAF/KRAS G12C/PD-L1 testing mandatory in advanced NSCLC (NCCN 2024 NSCLC)

Relative contraindication to checkpoint inhibitors (NCCN 2024 NSCLC)

* = hard-required. Engine cannot meaningfully run until these are filled.

Severity triggers (4)

4 need judgement
  • informationallife_threateningsvc_syndrome
    Superior vena cava syndrome — facial/upper extremity oedema, dyspnoea, JVD from mediastinal mass compression (NCCN 2024 NSCLC)
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationallife_threateningmassive_hemoptysis
    Hemoptysis >200 mL/24h or haemodynamic instability from pulmonary haemorrhage (NCCN 2024 NSCLC)
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationalseverebrain_mets_symptomatic
    Symptomatic brain metastases — headache, focal deficits, seizure, midline shift (NCCN 2024 NSCLC)
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationalsevereimmune_related_pneumonitis
    Grade >=2 immune-related pneumonitis on checkpoint inhibitor (NCCN 2024 NSCLC)
    Trigger could not be auto-evaluated — needs clinician judgement.

Workflow calculators

This dossier does not reference any calculators.

Recommended regimen

Early-stage (I-II) — surgery +/- adjuvant
axis: nsclc_early_stage
Selected axis "Early-stage (I-II) — surgery +/- adjuvant" by default fallback (first axis)
  • lobectomy
    first line
    surgical_resection
    Anatomic resection preferred for stage I-II; mediastinal lymph node sampling required (NCCN 2024 NSCLC)
  • SBRT
    first line
    radiation_therapy
    triggers: medically_inoperable, patient_refuses_surgery
    Stereotactic body RT for medically inoperable stage I (NCCN 2024 NSCLC)
  • cisplatin
    add on
    platinum_alkylating
    75 mg/m2 • IV • q3w x 4 cycles
    triggers: stage_II, stage_IB_>4cm
    Adjuvant cisplatin-based doublet for stage II (LACE meta-analysis, Pignon JCO 2008)
    rxcui 2555
  • vinorelbine
    add on
    vinca_alkaloid
    25 mg/m2 • IV • days 1,8 q3w x 4
    triggers: adjuvant_doublet_partner
    Preferred cisplatin partner in adjuvant setting (LACE meta-analysis)
    rxcui 39541
  • osimertinib
    add on
    EGFR_TKI_3rd_gen
    80 mg • PO • once daily x 3 years
    triggers: resected_IB-IIIA_EGFR_exon19del_or_L858R
    ADAURA — adjuvant osimertinib DFS benefit in EGFR-mutant resected NSCLC (Wu NEJM 2020)
    rxcui 1721560
  • atezolizumab
    add on
    PD_L1_inhibitor
    1200 mg • IV • q3w x 16 cycles
    triggers: resected_II-IIIA_PD_L1_>=1%_no_EGFR_ALK
    IMpower010 — adjuvant atezolizumab after adjuvant chemo for PD-L1 >=1% (Felip Lancet 2021)
    rxcui 1792776

Auto-drafted A&P note

Subjective

- Possible entry pathways: Incidental or screening-detected lung nodule (NCCN 2024 NSCLC); Persistent cough >3 weeks, hemoptysis, weight loss (NCCN 2024 NSCLC); Biopsy-confirmed NSCLC (NCCN 2024 NSCLC).

Objective

- No vitals, labs, or imaging entered for this encounter.

Assessment

**Non-small cell lung cancer (NSCLC)** (onc.lung-cancer.core.v1).
Phenotype framing: Histologic subtype (adenocarcinoma vs squamous vs large cell vs NOS); rule out SCLC, carcinoid, mesothelioma, metastatic disease to lung (NCCN 2024 NSCLC)
Scope: Determine scope: LDCT screening vs nodule workup vs confirmed NSCLC staging/treatment (NCCN 2024 NSCLC)

No severity triggers fired against current inputs.

Plan

Regimen axis: **Early-stage (I-II) — surgery +/- adjuvant**.
1. lobectomy (surgical_resection, first line) — Anatomic resection preferred for stage I-II; mediastinal lymph node sampling required (NCCN 2024 NSCLC)
2. SBRT (radiation_therapy, first line) — Stereotactic body RT for medically inoperable stage I (NCCN 2024 NSCLC)
3. cisplatin 75 mg/m2 IV q3w x 4 cycles (platinum_alkylating, add on) — Adjuvant cisplatin-based doublet for stage II (LACE meta-analysis, Pignon JCO 2008)
4. vinorelbine 25 mg/m2 IV days 1,8 q3w x 4 (vinca_alkaloid, add on) — Preferred cisplatin partner in adjuvant setting (LACE meta-analysis)
5. osimertinib 80 mg PO once daily x 3 years (EGFR_TKI_3rd_gen, add on) — ADAURA — adjuvant osimertinib DFS benefit in EGFR-mutant resected NSCLC (Wu NEJM 2020)
6. atezolizumab 1200 mg IV q3w x 16 cycles (PD_L1_inhibitor, add on) — IMpower010 — adjuvant atezolizumab after adjuvant chemo for PD-L1 >=1% (Felip Lancet 2021)

AVOID / contraindication checks:
- Cisplatin_avoid_CrCl_<60 (NCCN 2024 NSCLC)
- Osimertinib_avoid_QTc_>500ms (ADAURA, Wu NEJM 2020)
- Immunotherapy_avoid_active_autoimmune_disease (NCCN 2024 NSCLC)

Monitoring

Regimen monitoring:
- CT chest q6mo x2yr then annually (NCCN 2024 NSCLC)
- PFTs post resection (NCCN 2024 NSCLC)
- EGFR mutation retest at recurrence (NCCN 2024 NSCLC)

Follow-up plan: Survivorship care plan, smoking cessation, palliative care integration, advance care planning, clinical trial eligibility assessment at progression (NCCN 2024 NSCLC)
- Close-out criterion: Survivorship or palliative care plan documented; next scan scheduled (NCCN 2024 NSCLC)

Monitoring phase: CT q3-6 months for 2 years then annually; PFTs post-surgery; molecular resistance testing at progression; irAE monitoring on immunotherapy (LFT, TSH, glucose q2-4 weeks) (NCCN 2024 NSCLC)

Disposition

Disposition phase: Outpatient for systemic therapy; inpatient for surgical resection, post-op complications, or oncologic emergencies (NCCN 2024 NSCLC)
- Advance when: Care setting and treatment initiation timeline established (NCCN 2024 NSCLC)

Earlier-Return Triggers

Return-precaution thresholds (watch for):
- [LIFE_THREATENING] Superior vena cava syndrome — facial/upper extremity oedema, dyspnoea, JVD from mediastinal mass compression (NCCN 2024 NSCLC)
- [LIFE_THREATENING] Hemoptysis >200 mL/24h or haemodynamic instability from pulmonary haemorrhage (NCCN 2024 NSCLC)
- [SEVERE] Symptomatic brain metastases — headache, focal deficits, seizure, midline shift (NCCN 2024 NSCLC)

Citations

- NCCN 2024 NSCLC v5 + ASCO 2023 Molecular Testing Guideline [PMID:29151359](https://pubmed.ncbi.nlm.nih.gov/29151359/)
- Cited evidence (PMID 27718847) [PMID:27718847](https://pubmed.ncbi.nlm.nih.gov/27718847/)
- Cited evidence (PMID 29658856) [PMID:29658856](https://pubmed.ncbi.nlm.nih.gov/29658856/)
- Cited evidence (PMID 32955177) [PMID:32955177](https://pubmed.ncbi.nlm.nih.gov/32955177/)
- Cited evidence (PMID 30280658) [PMID:30280658](https://pubmed.ncbi.nlm.nih.gov/30280658/)

Last reconciled with current guidelines: 2026-05-25.
References