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 .
A randomized study of gemcitabine plus cisplatin and vinorelbine plus cisplatin in patients with advanced non-small-cell lung cancer.
BACKGROUND Gemcitabine plus cisplatin ( GC ) and vinorelbine plus cisplatin ( VC ) are active and well-tolerated regimens for the treatment of patients with advanced non-small-cell lung cancer ( NSCLC ) . We conducted this study to compare the safety and efficacy of these regimens as front-line chemotherapy for patients with NSCLC . METHODS Eligible patients were r and omized to receive either gemcitabine ( 1000 mg/m2 ) on days 1 , 8 , and 15 plus cisplatin ( 80 mg/m2 ) on day 15 ( arm GC ) , or vinorelbine ( 20 mg/m2 ) on days 1 , 8 , and 15 plus cisplatin ( 80 mg/m2 ) on day 15 ( arm VC ) . Treatments were repeated every 28 days . The costs of treatment were retrieved from the Health Care Reporting System of Chang Gung Memorial Hospital at the time of final data analysis . RESULTS Eighty-three patients ( GC , n=39 ; VC , n=44 ) were enrolled in the study . Seventy-three patients were analyzed .  Response rates were 38 % and 31 % and median survivals were 12.9 and 9.0 months for the 34 patients in the GC arm and 39 patients in the VC arm , respectively . One-year survival was 55.9 % in the GC arm and 33.3 % in the VC arm . There was no difference in the response rate ( p=0.622 ) , progression free survival ( p=0.443 ) and median survival ( p = 0.4197 ) between the two arms . Grade 3 - 4 toxicities were vomiting ( GC : 16.3 % vs. VC : 36.3 % ) , neutropenia ( GC : 14.7 % vs. VC : 20 % ) , and thrombocytopenia ( GC : 8.68 % vs. VC : 5 % ) . There was a significant increase in all- grade thrombocytopenia ( p=0.002 ) in the GC arm . The GC arm had higher total expenses than the VC arm ( p=0.020 ) . CONCLUSIONS Both vinorelbine plus cisplatin and gemcitabine plus cisplatin yielded similar efficacies for NSCLC
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 .