ASCO initiated its guideline program in 1993 and published the first guideline on colony stimulating factors in 1994.1 ASCO has evolved from publishing one or two guidelines annually to maintaining a robust library of over 118 guidelines with new guidelines added annually. Today, ASCO publishes approximately 20 to 25 guidelines per year, adhering to the rigorous evidence-based standards set by the Council of Medical Specialty Societies (CMSS) and the National Academy of Medicine (formerly Institute of Medicine).2,3
However, the rapid pace of oncology research presents a significant challenge of maintaining the currency and validity of these recommendations. To meet this demand, ASCO launched its Living Guidelines program.
Living Guidelines Program
Living Guidelines are developed for selected topic areas with rapidly evolving evidence that drives frequent change in recommended clinical practice. Living Guidelines are updated on a regular schedule by a standing Expert Panel that systematically reviews the medical health literature on a continuous basis, as described in the ASCO Guidelines Methodology Manual.4 In 2022, the first Living Guidelines on stage IV non–small cell lung cancer, which is divided into two guidelines, with and without driver alterations, were published.5,6 Approximately every 8 weeks, the literature is reviewed and a determination is made by the Expert Panel if any recommendation revisions are warranted. If revisions are needed, a short manuscript is reviewed by the Evidence-Based Medicine Committee, the approval body for ASCO guidelines, and submitted to the Journal of Clinical Oncology. If an update to the recommendations is not warranted, then the data tables are updated and no publication is submitted.
Specialty Areas
ASCO has recently expanded Living Guidelines to additional specialty areas including recommendation on the “Treatment of Multiple Myeloma” and “Systemic Therapy in Patients With Metastatic Castration-Resistant Prostate Cancer.”7,8 Further Living Guidelines are in development for metastatic castration-sensitive prostate cancer, advanced colorectal cancer, immunotherapy and targeted therapy for advanced gastresophageal cancer, treatment of ovarian cancer recurrence, management of immune adverse events, early stage breast cancer, metastatic breast cancer, and stage I-III non–small cell lung cancer.
ASCO is currently working to improve the process and dissemination of Living Guidelines. ASCO is exploring collaborations with organizations to use artificial intelligence (AI) in the systematic review process. A systematic review of the literature can take months, depending on the topic; however, by utilizing AI technology, the timeline can be significantly reduced to weeks if not days. In addition, under the existing publication model with JCO journals, Living Guidelines are segmented into several smaller publications and there is no definitive location to view a complete, full Living Guideline on a specific topic. ASCO is working to create a dedicated web space for the most up-to-date, complete version of each Living Guideline. In addition, ASCO guidelines will have a Journal of Clinical Oncology “Just Accepted” feature to greatly speed up the publication process and make the recommendations available to ASCO members faster.
Living Guidelines benefit ASCO membership by providing up-to-date, evidence-based guidance developed by leading experts in the field. The goal is to have all our guidelines become Living Guidelines, which technology and process improvements will aid in accomplishing. All ASCO guidelines, including Living Guidelines, can be found at ascopubs.org/guidelines. We welcome new topic or evidence submissions via our online form. If you’re interested in participating on guideline Expert Panels [see the] volunteer interest form. Volunteers must be ASCO members to participate.
References
1. ASCO: American Society of Clinical Oncology. Recommendations for the use of hematopoietic colony-stimulating factors: evidence-based, clinical practice guidelines. J Clin Oncol 12:2471-2508, 1994.
2. Council of Medical Specialty Societies: Principles for the development of specialty society clinical guidelines. Published September 2012. https://cmss.org/standards/principles-for-clinical-guideline-development/ Accessed April 14, 2026.
3. ASCO. ASCO guidelines methodology manual. Updated May 29, 2025. https://cdn.bfldr.com/KOIHB2Q3/as/qr3pjw3xfmq2svntp76hpbm/Guidelines-Methodology-Manual Accessed April 14, 2026.
4. Graham R, Mancher M, Miller Wolman D, [Editors] et al: Institute of Medicine. Clinical practice guidelines we can trust. National Academies Press, 2011.
5. Singh N, Temin S, Baker S Jr, et al: Therapy for stage IV non-small-cell lung cancer with driver alterations: ASCO living guideline. J Clin Oncol 40:3310-3322, 2022.
6. Singh N, Temin S, Baker S Jr, et al: Therapy for stage IV non-small-cell lung cancer without driver alterations: ASCO living guideline. J Clin Oncol. 40:3323-3343, 2022.
7. Hicks LK, Messersmith HJ, Al Hadidi S, et al: Treatment of multiple myeloma: ASCO-Ontario Health (Cancer Care Ontario) living guideline. J Clin Oncol 44(10):914-941, 2026.
8. Taplin M-E, Riaz IB, Rumble RB, et al: Systemic therapy in patients with metastatic castration-resistant prostate cancer: ASCO living guideline, Version 2026.1. J Clin Oncol 44(6):e1-e14, 2026.
Originally published in ASCO Daily News. © American Society of Clinical Oncology. ASCO Daily News, May 14, 2026. All rights reserved.
