ASCO Updates Guidelines for Advanced Lung Cancer

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An expert panel of ASCO developed recommendations for advanced lung cancer treatment after reviewing published literature.

The American Society of Clinical Oncology (ASCO) today released an update to its clinical practice guideline for stage IV non-small cell lung cancer. Published in the Journal of Clinical Oncology, the guidance provides recommendations for using systemic therapy—chemotherapy as well as targeted therapy—in first-, second-, and third-line regimens. Following a systematic review of published literature over a 7 year period between January 2007 and February 2014, a panel of experts from ASCO developed the following key recommendations:

First-line treatment

  • If tumor lacks EGFR or ALK gene alterations, combination cytotoxic chemotherapy for patients with performance status 0-1 is recommended. For patients with performance status 2, chemotherapy or palliative care alone may be used.
  • If tumor has sensitizing EGFR mutations, afatinib, erlotinib, or gefitinib is recommended.
  • If tumor has ALK or ROS1 gene rearrangements, crizotinib is recommended.

Maintenance treatment (treatment after initial response to first-line treatment)

  • Patients may be recommended to either switch to another regimen, or continue first-line therapy, or take a break from chemotherapy.

Second-line treatment

  • Docetaxel, erlotinib, or gefinitib are options; pemetrexed is an additional option for patients with non-squamous cell carcinoma.
  • Patients with EGFR mutations can receive chemotherapy or another EGFR inhibitor, depending on initial response.
  • Patients with ALK rearrangements may be offered chemotherapy or ceritinib.

Third-line treatment

  • Erlotinib may be offered for patients with performance status 0-3 who have not previously received erlotinib or gefitinib.

Emphasizing that age alone should not be a factor in the selection of treatment, the guideline recommends early palliative care, along with antitumor treatment.