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ASCO Updates Guideline on Therapy for Advanced Lung Cancer

Experts offer recommendations on use of chemotherapy and targeted treatments

A committee of oncology experts has updated the American Society of Clinical Oncology’s (ASCO) clinical practice guideline on systemic therapy for patients with stage IV non–small-cell lung cancer (NSCLC). Their recommendations are based on a systematic review of randomized controlled trials conducted from January 2007 to February 2014.

The new guideline update is targeted at health care providers (including medical oncologists, nurses, social workers, and any other relevant members of comprehensive multidisciplinary cancer care teams) as well as patients and their caregivers worldwide.

“Although there is no cure for patients with stage IV non–small-cell lung cancer, various treatment options are available that can help patients control their cancer longer,” said Gregory Masters, MD, co-chair of the ASCO expert panel that developed the guideline. “This guideline will help doctors choose the most appropriate therapies, depending on the biology of the tumor and the patient’s general well-being.”

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, the guidelines recommend cytotoxic chemotherapy, guided by histology, with early concurrent palliative care.

Treatment 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 there are 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; and crizotinib for those with ALK or ROS1 gene rearrangement. Recommended maintenance therapy includes pemetrexed continuation for patients with stable disease or a response to first-line pemetrexed-containing regimens, alternative chemotherapy, or a chemotherapy break.

In the second-line setting, recommended treatments include docetaxel, erlotinib, gefitinib, or pemetrexed for patients with non-squamous 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. According to the new guidelines, there are insufficient data to recommend routine third-line cytotoxic therapy.

“Early palliative care is associated with improved survival of patients with advanced lung cancer,” said Dr. David H. Johnson, co-chair of the ASCO expert panel. “Hospice care also improves patient quality of life and reduces caregiver distress.”

Sources: ASCO; August 31, 2015; and JCO; August 31, 2015.

 

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