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 .
Purpose To provide evidence -based recommendations to up date the American Society of Clinical Oncology guideline on systemic therapy for stage IV non – small-cell lung cancer ( NSCLC ) .
Results This guideline up date reflects changes in evidence since the previous guideline .
Docetaxel vs. vinorelbine in elderly patients with advanced non--small-cell lung cancer: a hellenic oncology research group randomized phase III study.
BACKGROUND / PURPOSE This study compared front-line treatment with docetaxel or vinorelbine in elderly patients with advanced/metastatic non-small-cell lung cancer ( NSCLC ) . PATIENTS AND METHODS Chemotherapy-naive patients with inoperable stage IIIB and stage IV NSCLC who were > 65 years of age with performance status ( PS ) of 0 - 2 were enrolled . Patients were assigned to receive either docetaxel 38 mg/m(2 ) or vinorelbine 25 mg/m(2 ) by intravenous ( I.V. ) infusion on days 1 and 8 every 3 weeks . RESULTS One hundred thirty elderly patients were enrolled in the study  ( docetaxel n = 66 and vinorelbine n = 64 patients ) . The objective response rate was 12.1 % and 14.1 % in patients treated with docetaxel and vinorelbine , respectively ( 2P = .799 ) . The median time to tumor progression ( TTP ) was 2.33 and 1.9 months ( 2P = .298 ) and the median overall survival ( OS ) was 6.07 and 3.87 months ( 2P = .090 ) in the docetaxel and vinorelbine arms , respectively . Grade 3/4 neutropenia occurred in 4.5 % and 29.7 % of patients in the docetaxel arm and vinorelbine arm , respectively ( 2P < .001 ) . Febrile neutropenia occurred in 1.5 % and 1.6 % of patients in the docetaxel arm and the vinorelbine arm , respectively ( 2P = .950 ) and the use of granulocyte colony-stimulating factor ( G-CSF ) was more frequent in patients treated with vinorelbine ( 37.1 % vs. 22.5 % ; 2P < .001 ) . There were no deaths from toxicity . Nonhematologic toxicity was mild . CONCLUSIONS Docetaxel has an efficacy comparable to that of vinorelbine as first-line treatment in elderly patients with NSCLC and has an acceptable toxicity profile . The trial was closed prematurely because of low accrual , thus limiting the strength of the conclusions derived
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 .
Purpose To provide evidence -based recommendations to up date the American Society of Clinical Oncology guideline on systemic therapy for stage IV non – small-cell lung cancer ( NSCLC ) .
Results This guideline up date reflects changes in evidence since the previous guideline .