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 .
Phase III trial of vandetanib compared with erlotinib in patients with previously treated advanced non-small-cell lung cancer.
PURPOSE V and etanib is a once-daily oral inhibitor of vascular endothelial growth factor receptor and epidermal growth factor receptor signaling . This phase III study assessed the efficacy of v and etanib versus erlotinib in unselected patients with advanced non-small-cell lung cancer ( NSCLC ) after treatment failure with one to two prior cytotoxic chemotherapy regimens . PATIENTS AND METHODS One thous and two hundred forty patients were r and omly assigned to receive v and etanib 300 mg/d ( n = 623 ) or erlotinib 150 mg/d ( n = 617 ) . The primary objective was to show superiority in progression-free survival ( PFS ) for v and etanib versus erlotinib . If the difference did not reach statistical significance for superiority , a noninferiority analysis was conducted . RESULTS There was no significant improvement in PFS for patients treated with v and etanib versus erlotinib ( hazard ratio [ HR ] , 0.98 ; 95.22 % CI , 0.87 to 1.10 ; P = .721 ) ; median PFS was 2.6 months for v and etanib and 2.0 months for erlotinib . There was also no significant difference for the secondary end points of overall survival ( HR , 1.01 ; P = .830 ) , objective response rate ( both 12 % ) , and time to deterioration of symptoms for pain ( HR , 0.92 ; P = .289 ) , dyspnea ( HR , 1.07 ; P = .407 ) , and cough ( HR , 0.94 ; P = .455 ) . Both agents showed equivalent PFS and overall survival in a preplanned noninferiority analysis . Adverse events ( AEs ; any grade ) more frequent with v and etanib than erlotinib included diarrhea ( 50 % v 38 % , respectively ) and hypertension ( 16 % v 2 % , respectively ) ; rash was more frequent with erlotinib than v and etanib ( 38 % v 28 % , respectively ) . The overall incidence of grade ≥ 3 AEs was also higher with v and etanib than erlotinib ( 50 % v 40 % , respectively ) . CONCLUSION In patients with previously treated advanced NSCLC  , v and etanib showed antitumor activity but did not demonstrate an efficacy advantage compared with erlotinib . There was a higher incidence of some AEs with v and etanib
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 .