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 .
Safety, Resource Use, and Quality of Life in Paramount: A Phase III Study of Maintenance Pemetrexed Versus Placebo after Induction Pemetrexed Plus Cisplatin for Advanced Nonsquamous Non–Small-Cell Lung Cancer
Introduction : In a phase III , r and omized , double-blind study ( PARAMOUNT ) , maintenance pemetrexed demonstrated significant benefit in advanced non – small-cell lung cancer ( NSCLC ) . We present safety , re source use , and quality of life ( QoL ) results . Methods : After four 21-day cycles of pemetrexed-cisplatin  ( N = 939 ) , patients with advanced nonsquamous NSCLC , whose disease had not progressed and who had a performance status of 0/1 , were r and omized 2:1 ( N = 539 ) to maintenance pemetrexed 500 mg/m2 plus best supportive care or placebo plus best supportive care every 21 days until disease progression or unacceptable toxicity . QoL was measured using the EuroQol 5-dimensional question naire ( EQ-5D ) . Results : Frequently reported grade 3 to 4 drug-related toxicities with maintenance pemetrexed versus placebo were anemia ( 4.5 % versus 0.6 % ; p = 0.016 ) , fatigue ( 4.2 % versus 0.6 % ; p = 0.016 ) , and neutropenia ( 3.6 % versus 0.0 % ; p < 0.006 ) . No significant differences in drug-related grade 3 to 5 toxicities were observed with long-term pemetrexed exposure ( > 6 cycles ) , except grade 3 to 4 neutropenia , which did not result in increased infections . Patients on maintenance pemetrexed  required more transfusions ( 13.4 % versus 5.0 % ; p = 0.003 ) , granulocyte colony- or granulocyte-macrophage colony-stimulating factors ( 5.3 % versus 0.0 % ; p < 0.001 ) , anti-infectives ( 25.3 % versus 16.7 % ; p = 0.028 ) , and hospitalizations because of study drug ( 8.4 % versus 3.3 % , p = 0.028 ) than placebo-treated patients did . No significant treatment-by-time interactions , overall treatment differences , or clinical ly relevant changes from baseline were observed in EQ-5D scores during treatment . Conclusions : Long-term use of continuation maintenance pemetrexed was well tolerated ; re source use was low , corresponding with known pemetrexed toxicities . The EQ-5D results demonstrate that patients tolerate long-term maintenance pemetrexed without worsening
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 .