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 .
Looking Beyond Surveillance, Epidemiology, and End Results: Patterns of Chemotherapy Administration for Advanced Non-small Cell Lung Cancer in a Contemporary, Diverse Population
Introduction : Chemotherapy prolongs survival without substantially impairing quality of life for medically fit patients with advanced non-small cell lung cancer ( NSCLC ) , but population -based studies have shown that only 20 to 30 % of these patients receive chemotherapy . These earlier studies have relied on Medicare-linked Surveillance , Epidemiology , and End Results ( SEER ) data , thus excluding the 30 to 35 % of lung cancer patients younger than 65 years . Therefore , we determined the use of chemotherapy in a contemporary , diverse NSCLC population encompassing all patient ages . Methods : We performed a retrospective analysis of patients diagnosed with stage IV NSCLC from 2000 to 2007 at the University of Texas Southwestern Medical Center . Demographic , treatment , and outcome data were obtained from hospital tumor registries . The association between these variables was assessed using univariate analysis and multivariate logistic regression . Results : In all , 718 patients met criteria for analysis . Mean age was 60 years , 58 % were men , and 45 % were white . Three hundred fifty-three patients ( 49 % ) received chemotherapy . In univariate analysis , receipt of chemotherapy  was associated with age ( 53 % of patients younger than 65 years versus 41 % of patients aged 65 years and older ; p = 0.003 ) and insurance type ( p < 0.001 ) . In a multivariate model , age and insurance type remained associated with receipt of chemotherapy . For individuals receiving chemotherapy , median survival was 9.2 months , compared with 2.3 months for untreated patients ( p < 0.001 ) . Conclusions : In a contemporary population representing the full age range of patients with advanced NSCLC , chemotherapy was administered to approximately half of all patients —more than twice the rate reported in some earlier studies . Patient age and insurance type are associated with receipt of chemotherapy
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 .