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 .
Symptom control and quality of life in LUX-Lung 3: a phase III study of afatinib or cisplatin/pemetrexed in patients with advanced lung adenocarcinoma with EGFR mutations.
PURPOSE Patient-reported symptoms and health-related quality of life ( QoL ) benefits were investigated in a r and omized , phase III trial of afatinib or cisplatin/pemetrexed . PATIENTS AND METHODS Three hundred forty-five patients with advanced epidermal growth factor receptor ( EGFR ) mutation-positive lung adenocarcinoma were r and omly assigned 2:1 to afatinib 40 mg per day or up to six cycles of cisplatin/pemetrexed .  Lung cancer symptoms and health-related QoL were assessed every 21 days until progression using the European Organisation for Research and Treatment of Cancer Quality of Life Question naire C30 and Lung Cancer-13 question naires . Analyses of cough , dyspnea , and pain were preplanned , including percentage of patients who improved on therapy , time to deterioration of symptoms , and change in symptoms over time . RESULTS Question naire compliance was high . Compared with chemotherapy , afatinib significantly delayed the time to deterioration for cough ( hazard ratio [ HR ] , 0.60 ; 95 % CI , 0.41 to 0.87 ; P = .007 ) and dyspnea ( HR , 0.68 ; 95 % CI , 0.50 to 0.93 ; P = .015 ) , but not pain ( HR , 0.83 ; 95 % CI , 0.62 to 1.10 ; P = .19 ) . More patients on afatinib ( 64 % ) versus chemotherapy ( 50 % ) experienced improvements in dyspnea scores ( P = .010 ) . Differences in mean scores over time significantly favored afatinib over chemotherapy for cough ( P < .001 ) and dyspnea ( P < .001 ) . Afatinib showed significantly better mean scores over time in global health status/QoL ( P = .015 ) and physical ( P < .001 ) , role ( P = .004 ) , and cognitive ( P = .007 ) functioning compared with chemotherapy . Fatigue and nausea were worse with chemotherapy , whereas diarrhea , dysphagia , and sore mouth were worse with afatinib ( all P < .01 ) . CONCLUSION In patients with lung adenocarcinoma with EGFR mutations , first-line afatinib was associated with better control of cough and dyspnea compared with chemotherapy , although diarrhea , dysphagia , and sore mouth were worse . Global health status/QoL was also improved over time with afatinib compared with chemotherapy
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 .