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 .
Symptom and Quality of Life Benefit of Afatinib in Advanced Non–Small-Cell Lung Cancer Patients Previously Treated with Erlotinib or Gefitinib: Results of a Randomized Phase IIb/III Trial (LUX-Lung 1)
Background : Patient-reported symptom and health-related quality of life ( HRQoL ) benefit of afatinib , a novel , irreversible , ErbB Family Blocker , was investigated in a double-blind , r and omized , phase IIb/III trial ( LUX-Lung 1 ) . Methods : Five hundred and eighty-five patients with lung adenocarcinoma ( stage IIIb/IV ) , who had progressed after chemotherapy ( 1–2 lines ) and at least 12 weeks of erlotinib or gefitinib , were r and omized ( 2:1 ) to receive either afatinib plus best supportive care ( BSC ) or placebo plus BSC .  Symptom and HRQoL benefit were measured using the lung cancer-specific European Organisation for Research and Treatment of Cancer ( QLQ-C30/LC13 ) and EuroQol ( EQ-5D ) question naires . Non – small-cell lung cancer – related symptoms ( cough , dyspnea , and pain ) were prespecified using three preplanned analyses ( percentage of patients improved/worsened/stable , change in scores over time , and time to deterioration of scores ) . Results : Compared with patients on placebo , a significantly higher proportion of afatinib-treated patients showed an improvement in cough ( p < 0.0001 ) , dyspnea ( p = 0.006 ) , and pain ( p < 0.0001 ) . Afatinib also significantly improved the mean scores over time for cough ( p < 0.0001 ) , dyspnea ( p = 0.0161 ) , and pain ( p = 0.0056 ) ; significantly delayed the time to deterioration for cough ( p < 0.001 ) ; and showed a trend in delaying dyspnea ( p = 0.170 ) and pain ( p = 0.287 ) . Consistent with the adverse-event profile of afatinib , a significantly ( p < 0.05 ) higher proportion of afatinib-treated patients showed worsening of diarrhea , sore mouth , dysphagia , and appetite scores . However , compared with placebo , afatinib significantly ( p < 0.05 ) improved QoL assessed with the EQ-5D question naire and global health status/QoL , physical functioning , and fatigue , which were assessed with the European Organisation for Research and Treatment of Cancer question naires . Conclusion : In the LUX-Lung 1 trial , the addition of afatinib to BSC significantly improved non – small-cell lung cancer – related symptoms ( cough , dyspnea , and pain ) , fatigue , physical functioning , and HRQoL and significantly delayed time to deterioration of cough
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 .