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 .
Phase II study of pemetrexed and carboplatin plus bevacizumab with maintenance pemetrexed and bevacizumab as first-line therapy for nonsquamous non-small-cell lung cancer.
PURPOSE This study evaluated the efficacy and safety of pemetrexed , carboplatin , and bevacizumab followed by maintenance pemetrexed and bevacizumab in patients with chemotherapy-naive stage IIIB ( effusion ) or stage IV nonsquamous non-small-cell lung cancer ( NSCLC ) . PATIENTS AND METHODS Patients received pemetrexed 500 mg/m(2 ) , carboplatin area under the concentration-time curve of 6 , and bevacizumab 15 mg/kg every 3 weeks for six cycles . For patients with response or stable disease , pemetrexed and bevacizumab were continued until disease progression or unacceptable toxicity . RESULTS Fifty patients were enrolled and received treatment . The median follow-up was 13.0 months , and the median number of treatment cycles was seven ( range , one to 51 ) . Thirty patients ( 60 % ) completed > or = six treatment cycles , and nine ( 18 % ) completed > or = 18 treatment cycles . Among the 49 patients assessable for response , the objective response rate was 55 % ( 95 % CI , 41 % to 69 % ) . Median progression-free and overall survival rates were 7.8 months ( 95 % CI , 5.2 to 11.5 months ) and 14.1 months ( 95 % CI , 10.8 to 19.6 months ) , respectively . Grade 3/4 hematologic toxicity was modest-anemia ( 6 % ; 0 ) , neutropenia ( 4 % ; 0 ) , and thrombocytopenia ( 0 ; 8 % ) . Grade 3/4 nonhematologic toxicities were proteinuria ( 2 % ; 0 ) , venous thrombosis ( 4 % ; 2 % ) , arterial thrombosis ( 2 % ; 0 ) , fatigue ( 8 % ; 0 ) , infection ( 8 % ; 2 % ) , nephrotoxicity ( 2 % ; 0 ) , and diverticulitis ( 6 % ; 2 % ) . There were no grade 3 or greater hemorrhagic events or hypertension cases . CONCLUSION This regimen , involving a maintenance component , was associated with acceptable toxicity and relatively long survival in patients with advanced nonsquamous NSCLC . These results justify a phase III comparison against the st and ard-of-care in this patient population
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 .