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ASCO clinical practice guideline: systemic therapy for stage IV non–small-cell lung cancer


A Committee of the American Society of Clinical Oncology NSCLC Expert Panel carried out a systematic review of randomized controlled trials from January 2007 to February 2014 to provide evidence-based recommendations to update the American Society of Clinical Oncology ( ASCO ) guideline on systemic therapy for stage IV non–small-cell lung cancer ( NSCLC ).

There is no cure for patients with stage IV NSCLC.

For patients with performance status ( PS ) 0 to 1 ( and appropriate patient cases with PS 2 ) and without an EGFR-sensitizing mutation or ALK gene rearrangement, combination cytotoxic chemotherapy is recommended, guided by histology, with early concurrent palliative care.

Recommendations for patients in the first-line setting include Platinum-doublet therapy for those with PS 0 to 1 ( Bevacizumab may be added to Carboplatin plus Paclitaxel if no contraindications ); combination or single-agent chemotherapy or palliative care alone for those with PS 2; Afatinib, Erlotinib, or Gefitinib for those with sensitizing EGFR mutations; Crizotinib for those with ALK or ROS1 gene rearrangement; and following first-line recommendations or using Platinum plus Etoposide for those with large-cell neuroendocrine carcinoma.
Maintenance therapy includes Pemetrexed continuation for patients with stable disease or response to first-line Pemetrexed-containing regimens, alternative chemotherapy, or a chemotherapy break.

In the second-line setting, recommendations include Docetaxel, Erlotinib, Gefitinib, or Pemetrexed for patients with nonsquamous cell carcinoma; Docetaxel, Erlotinib, or Gefitinib for those with squamous cell carcinoma; and chemotherapy or Ceritinib for those with ALK rearrangement who experience progression after Crizotinib.

In the third-line setting, for patients who have not received Erlotinib or Gefitinib, treatment with Erlotinib is recommended. There are insufficient data to recommend routine third-line cytotoxic therapy.

Decisions regarding systemic therapy should not be made based on age alone. ( Xagena )

Source: ASCO, 2015

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