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 .
Health-Related Quality-of-Life in a Randomized Phase III First-Line Study of Gefitinib Versus Carboplatin/Paclitaxel in Clinically Selected Patients from Asia with Advanced NSCLC (IPASS)
Introduction : Evaluation of health-related quality -of-life ( HRQoL ) and symptom improvement were preplanned secondary objectives for the overall population and posthoc analyses for epidermal growth factor receptor ( EGFR ) mutation-positive/negative subgroups in IPASS . Methods : HRQoL was assessed using the Functional Assessment of Cancer Therapy-Lung ( FACT-L ) and Trial Outcome Index ( TOI ) ; symptom improvement by the Lung Cancer Subscale ( LCS ) . Improvements defined as : 6 or more ( FACT-L ; TOI ) , 2 or more ( LCS ) points increase maintained for 21 or more days . Results : Overall ( n = 1151/1217 evaluable ) , HRQoL improvement rates were significantly greater with gefitinib versus carboplatin/paclitaxel ;  symptom improvement rates were similar for both treatments . Significantly more patients recorded improvements in HRQoL and symptoms with gefitinib in the EGFR mutation-positive subgroup ( n = 259 ; FACT-L 70.2 % versus 44.5 % ; odds ratio , 3.01 [ 95 % confidence interval , 1.79–5.07 ] ; p < 0.001 ; TOI 70.2 % versus 38.3 % ; 3.96 [ 2.33–6.71 ] ; p < 0.001 ; LCS 75.6 % versus 53.9 % ; 2.70 [ 1.58–4.62 ] ; p < 0.001 ) , and with carboplatin/paclitaxel in the EGFR mutation-negative subgroup ( n = 169 ; FACT-L 14.6 % versus 36.3 % ; odds ratio , 0.31 [ 0.15–0.65 ] ; p = 0.002 ; TOI 12.4 % versus 28.8 % ; 0.35 [ 0.16–0.79 ] ; p = 0.011 ; LCS 20.2 % versus 47.5 % ; 0.28 [ 0.14–0.55 ] ; p < 0.001 ) . Median time-to-worsening ( months ) FACT-L score was longer with gefitinib versus carboplatin/paclitaxel for the overall population ( 8.3 versus 2.5 ) and EGFR mutation-positive subgroup ( 15.6 versus 3.0 ) , and similar for both treatments in the EGFR mutation-negative subgroup ( 1.4 versus 1.4 ) . Median time-to-improvement with gefitinib was 8 days in patients with EGFR mutation-positive tumors who improved . Conclusions : HRQoL and symptom endpoints were consistent with efficacy outcomes in IPASS and favored gefitinib in patients with EGFR mutation-positive tumors and carboplatin/paclitaxel in patients with EGFR mutation-negative tumors
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 .