Systemic therapy for stage IV non-small-cell lung cancer: American society of clinical oncology clinical practice guideline update

Gregory A. Masters, Sarah Temin, Christopher G. Azzoli, Giuseppe Giaccone, Sherman Baker, Julie R. Brahmer, Peter M. Ellis, Ajeet Gajra, Nancy Rackear, Joan H. Schiller, Thomas J. Smith, John R. Strawn, David Trent, David H. Johnson

Research output: Contribution to journalReview article

312 Scopus citations

Abstract

Purpose: To provide evidence-based recommendations to update the American Society of Clinical Oncology guideline on systemic therapy for stage IV non-small-cell lung cancer (NSCLC). Methods: An Update Committee of the American Society of Clinical Oncology NSCLC Expert Panel based recommendations on a systematic review of randomized controlled trials from January 2007 to February 2014. Results: This guideline update reflects changes in evidence since the previous guideline. Recommendations: 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. Additional information can be found at http://www.asco.org/guidelines/NSCLC and http://www.asco.org/guidelineswiki.

Original languageEnglish (US)
Pages (from-to)3488-3515
Number of pages28
JournalJournal of Clinical Oncology
Volume33
Issue number30
DOIs
StatePublished - Oct 20 2015

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Fingerprint Dive into the research topics of 'Systemic therapy for stage IV non-small-cell lung cancer: American society of clinical oncology clinical practice guideline update'. Together they form a unique fingerprint.

  • Cite this

    Masters, G. A., Temin, S., Azzoli, C. G., Giaccone, G., Baker, S., Brahmer, J. R., Ellis, P. M., Gajra, A., Rackear, N., Schiller, J. H., Smith, T. J., Strawn, J. R., Trent, D., & Johnson, D. H. (2015). Systemic therapy for stage IV non-small-cell lung cancer: American society of clinical oncology clinical practice guideline update. Journal of Clinical Oncology, 33(30), 3488-3515. https://doi.org/10.1200/JCO.2015.62.1342