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ASCO updates guideline on treatment of advanced NSCLC
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ASCO has updated its clinical practice guideline on systemic therapy for stage IV non–small cell lung cancer.
The evidence-based recommendations provide guidance on the use of chemotherapy as well as targeted therapy in the first-, second- and third-line settings.
“Although there is no cure for patients with stage IV NSCLC, various treatment options are available that can help patients control their cancer longer,” Gregory A. Masters MD, co-chair of the ASCO Expert Panel that developed the guideline, attending physician at Helen F. Graham Cancer Center and associate professor at Thomas Jefferson University Medical School, said in a press release. “This guideline will help doctors choose the most appropriate therapies, depending on the biology of the tumor and the patient’s general well-being.”
Gregory A. Masters
The panel conducted a systematic review of relevant medical literature published between January 2007 and February 2014 in an effort to update the guideline, which was last published in 2009.
The guideline contains the following recommendations for first-line treatment:
- Platinum doublet therapy is recommended for patients without EGFR or ALK mutations who have a performance status (PS) of 0 to 1.
- Patients with PS 2 may receive chemotherapy alone or palliative care.
- Patients with EGFR mutations should receive afatinib (Gilotrif, Boehringer Ingelheim), erlotinib (Tarceva; Genentech, Astells) or gefitinib (Iressa, AstraZeneca), whereas patients with ALK or ROS1 mutations should receive crizotinib (Xalkori, Pfizer).
- Patients with large-cell neuroendocrine carcinoma should receive platinum plus etoposide.
Following initial response from first-line treatment, the panel recommended patients switch regimens or continue first-line therapy as part of their maintenance treatment. Clinicians may also recommend taking a break from chemotherapy.
The panel made the following recommendations for the second-line setting:
- Docetaxel, erlotinib, gefitinib and pemetrexed (Alimta, Lilly) are recommended for patients with nonsquamous cell carcinoma.
- Docetaxel, erlotinib and gefitinib are recommended for patients with squamous cell carcinoma.
- Depending on initial response, patients with EGFR mutations may receive chemotherapy or another EGFR inhibitor.
- Patients with ALK mutations should be offered chemotherapy or ceritinib (Zykadia, Novartis).
In a third-line setting, patients with a PS of 0 to 3 should be offered erlotinib if they had not previously received it or gefitinib. However, the panel noted there is insufficient information to provide guidance on cytotoxic therapy in the third-line setting.
Finally, the guideline stressed that age alone should not be a factor in determining treatment, and that early palliative care in conjunction with anti-tumor treatment is recommended in this patient population.
David H. Johnson
“Early palliative care is associated with improved survival of patients with advanced lung cancer,” David H. Johnson, MD, co-chair of the ASCO Expert Panel and professor and chairman of internal medicine at The University of Texas Southwestern Medical Center, said in the release. “Hospice care also improves patient quality of life and reduces caregiver distress.” – by Anthony SanFilippo
Disclosure: Masters reports no relevant financial disclosures. Johnson reports consultant/advisory roles and other financial relationships with Peloton Therapeutics and miRNA Therapeutics. Please see the full study for a list of all other panel members’ financial disclosures.
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