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 .
Randomized double-blind placebo-controlled trial of thalidomide in combination with gemcitabine and Carboplatin in advanced non-small-cell lung cancer.
PURPOSE Cancers rely on angiogenesis for their growth and dissemination . We hypothesized that thalidomide , an oral antiangiogenic agent , when combined with chemotherapy , and as maintenance treatment , would improve survival in patients with advanced non-small-cell lung cancer ( NSCLC ) . PATIENTS AND METHODS Seven hundred twenty-two patients were r and omly assigned to receive placebo or thalidomide capsules 100 to 200 mg daily for up to 2 years . All patients received gemcitabine and carboplatin every 3 weeks for up to four cycles . End points were overall survival ( OS ) , progression-free survival ( PFS ) , response rate , grade 3/4 toxicity , and quality of life ( QoL ) . RESULTS The median OS rates were 8.9 months ( placebo ) and 8.5 months ( thalidomide ) . The hazard ratio ( HR ) was 1.13 ( 95 % CI , 0.97 to 1.32 ; P = .12 ) . The 2-year survival rate was 16 % and 12 % in the placebo and thalidomide arms , respectively . The PFS results were consistent with those for OS . The risk of having a thrombotic event was increased by 74 % in the thalidomide group : HR of 1.74 ( 95 % CI , 1.20 to 2.52 ; P = .003 ) . There were no differences in hematologic toxicities , but a slight excess of rash and neuropathy in the thalidomide group . QoL scores were similar but thalidomide was associated with less insomnia , and more constipation and peripheral neuropathy . In a retrospective analysis , patients with nonsquamous histology in the thalidomide group had a poorer survival : 2-year risk difference of 10 % ( 95 % CI , 4 % to 16 % ; P < .001 ) . CONCLUSION In this large trial of patients with NSCLC , thalidomide in combination with chemotherapy did not improve survival overall , but increased the risk of thrombotic events . Unexpectedly , survival was significantly worse in patients with nonsquamous histology
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 .