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 .
ATLAS: randomized, double-blind, placebo-controlled, phase IIIB trial comparing bevacizumab therapy with or without erlotinib, after completion of chemotherapy, with bevacizumab for first-line treatment of advanced non-small-cell lung cancer.
PURPOSE This phase III trial was performed to assess the potential benefit of adding maintenance erlotinib to bevacizumab after a first-line chemotherapy regimen with bevacizumab for advanced non-small-cell lung cancer ( NSCLC ) . PATIENTS AND METHODS One thous and one hundred forty-five patients with histologically or cytologically confirmed NSCLC ( stage IIIB with malignant pleural effusion , stage IV , or recurrent ) received four cycles of chemotherapy plus bevacizumab .  Seven hundred forty-three patients without disease progression or significant toxicity  were then r and omly assigned ( 1:1 ) to bevacizumab ( 15 mg/kg , day 1 , 21-day cycle ) plus either placebo or erlotinib ( 150 mg per day ) . The primary end point was progression-free survival ( PFS ) . RESULTS Median PFS from time of r and om assignment was 3.7 months with bevacizumab/placebo and 4.8 months with bevacizumab/erlotinib ( hazard ratio [ HR ] , 0.71 ; 95 % CI , 0.58 to 0.86 ; P < .001 ) . Median overall survival ( OS ) times from r and om assignment were 13.3 and 14.4 months with bevacizumab/placebo and bevacizumab/erlotinib , respectively ( HR , 0.92 ; 95 % CI , 0.70 to 1.21 ; P = .5341 ) . During the postchemotherapy phase , there were more adverse events ( AEs ) overall , more grade 3 and 4 AEs ( mainly rash and diarrhea ) , more serious AEs , and more AEs leading to erlotinib/placebo discontinuation in the bevacizumab/erlotinib arm versus the bevacizumab/placebo arm . The incidence of AEs leading to bevacizumab discontinuation was similar in both treatment arms . CONCLUSION The addition of erlotinib to bevacizumab significantly improved PFS but not OS . Although generally well tolerated , the modest impact on survival and increased toxicity associated with the addition of erlotinib to bevacizumab maintenance mean that this two-drug maintenance regimen will not lead to a new postchemotherapy st and ard of care
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 .