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 .
Vandetanib plus pemetrexed for the second-line treatment of advanced non-small-cell lung cancer: a randomized, double-blind phase III trial.
PURPOSE V and etanib is a once-daily oral inhibitor of vascular endothelial growth factor receptor and epidermal growth factor receptor signaling . This r and omized , placebo-controlled phase III study assessed the efficacy of v and etanib plus pemetrexed as second-line therapy in advanced non-small-cell lung cancer . PATIENTS AND METHODS Patients ( N = 534 ) were r and omly assigned to receive v and etanib 100 mg/d plus pemetrexed 500 mg/m(2 ) every 21 days ( n = 256 ) or placebo plus pemetrexed ( n = 278 ) . Progression-free survival ( PFS ) was the primary end point ; overall survival , objective response rate , disease control rate , time to deterioration of symptoms , and safety were secondary assessment s. RESULTS There was no significant difference in PFS between treatment arms ( hazard ratio [ HR ] , 0.86 ; 97.58 % CI , 0.69 to 1.06 ; P = .108 ) . Overall survival was also not significantly different ( HR , 0.86 ; 97.54 % CI , 0.65 to 1.13 ; P = .219 ) . Statistically significant improvements in objective response rate ( 19 % v 8 % ; P < .001 ) and time to deterioration of symptoms ( HR , 0.71 ; P = .0052 ; median , 18.1 weeks for v and etanib and 12.1 weeks for placebo ) were observed in patients receiving v and etanib . Adding v and etanib to pemetrexed increased the incidence of some adverse events , including rash , diarrhea , and hypertension , while showing a reduced incidence of nausea , vomiting , anemia , fatigue , and asthenia with no reduction in the dose intensity of pemetrexed . CONCLUSION This study did not meet the primary end point of statistically significant PFS prolongation with v and etanib plus pemetrexed versus placebo plus pemetrexed . The v and etanib combination showed a significantly higher objective response rate and a significant delay in the time to worsening of lung cancer symptoms versus the placebo arm as well as an acceptable safety profile in this patient population
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 .