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 .
Quality of Life Analysis of TORCH, a Randomized Trial Testing First-Line Erlotinib Followed by Second-Line Cisplatin/Gemcitabine Chemotherapy in Advanced Non–Small-Cell Lung Cancer
Introduction : The TORCH ( Tarceva or Chemotherapy ) trial r and omized patients with advanced non – small-cell lung cancer to first-line erlotinib followed by second-line cisplatin/gemcitabine versus . st and ard inverse sequence . The trial , design ed to test noninferiority in overall survival , was stopped at interim analysis because of inferior survival in the experimental arm . Quality of life ( QoL ) , a secondary outcome , is reported here . Methods : QoL was assessed at baseline and every 3 weeks during first-line , using European Organization for Research and Treatment of Cancer Quality of Life Question naire - Core 30 and QLQ – lung cancer specific module ( LC13 ) . Mean changes from baseline within arms were reported . QoL response and time-to-deterioration of QoL using a competing-risk approach were compared between treatment arms . Results : Six hundred and thirty patients ( 83 % ) completed baseline question naires . Compliance was affected by differential treatment efficacy , but was similar between arms for patients without progression or death . Significant differences in QoL responses were observed favoring chemotherapy for pain , sleeping , dyspnea , diarrhea , and favoring erlotinib for vomiting , constipation , sore mouth , and alopecia . In the small subset of patients with EGFR-mutated tumors , all selected items ( global QoL , physical functioning , cough , dyspnea and pain ) improved , whereas worsening or no change was observed in wild-type patients . Improvement was particularly evident in the first-line erlotinib arm as for global QoL and physical functioning . Conclusions : QoL was impacted by differential toxicity and efficacy between arms . Functional domains and global QoL did not differ , although some symptoms were better controlled with chemotherapy in unselected non – small-cell lung cancer patients
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 .