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 .
Influence of comorbidity on survival, toxicity and health-related quality of life in patients with advanced non-small-cell lung cancer receiving platinum-doublet chemotherapy.
AIM OF THE STUDY To investigate whether patients with severe comorbidity receiving platinum-based chemotherapy for advanced non-small-cell lung cancer ( NSCLC ) have a shorter overall survival , experience more toxicity or more deterioration of health-related quality of life ( HRQoL ) than other patients during treatment . PATIENTS AND METHODS Patients enrolled onto a phase III trial comparing pemetrexed/carboplatin with gemcitabine/carboplatin as first-line therapy of stage IIIB/IV NSCLC were analysed . Eligible patients had performance status 0 - 2 and adequate kidney/liver/bone-marrow function .  Comorbidity was assessed from hospital medical records using the Cumulative Illness Rating Scale for Geriatrics ( CIRS-G ) . Toxicity was grade d using the CTCAE v3.0 and the patients reported HRQoL on the European Organisation for Research and Treatment of Cancer ( EORTC ) Quality of Life Question naire (QLQ)-C30/LC13 . RESULTS Data from 402 of the 436 of the patients enrolled onto the phase III trial were analysed . The patients with severe comorbidity had similar survival as other patients ( 6.9 versus 8.1months ; p=.34 ) , similar frequency of neutropenia ( 48 % versus 42 % ; p=.16 ) , but experienced more neutropenic fevers ( 12 % versus 5 % ; p=.012 ) and deaths from neutropenic infections ( 3 % versus 0 % ; p=.027 ) . They had more thrombocytopenia ( 46 % versus 36 % ; p=.03 ) , but not more thrombocytopenic bleedings ( 3 % versus 4 % ; p=.65 ) . In general , the patients with severe comorbidity reported poorer HRQoL , but not significantly more deterioration of HRQoL. CONCLUSIONS The results from our study suggest that patients with advanced NSCLC who have severe co-existing disorders benefit from and tolerate platinum-doublet chemotherapy as well as other patients . They do , however , appear to have a higher risk of acquiring infections when neutropenic
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 .