What are the ASCO recommendations on staged therapy for stage IV non–small cell lung cancer (NSCLC)?

Updated: Jun 05, 2020
  • Author: Winston W Tan, MD, FACP; Chief Editor: Nagla Abdel Karim, MD, PhD  more...
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Answer

American Society of Clinical Oncology (ASCO) guidelines on chemotherapy for stage IV disease includes the following recommendations [215] :

First-line therapy

  • Platinum-doublet therapy for patients with PS 0 to 1 (bevacizumab may be added to carboplatin plus paclitaxel if no contraindications)
  • Combination or single-agent chemotherapy or palliative care alone for patients with PS 2
  • Afatinib, erlotinib, or gefitinib for patients with sensitizing  EGFR mutations
  • Crizotinib for patients with  ALK or  ROS1 gene rearrangement
  • Other recommended first-line regimens or platinum plus etoposide for patients with large-cell neuroendocrine carcinoma

Maintenance therapy 

  • Pemetrexed continuation for patients with stable disease or response to first-line pemetrexed-containing regimens
  • Alternative chemotherapy
  • A chemotherapy break

Second-line therapy 

  • Docetaxel, erlotinib, gefitinib, or pemetrexed for patients with nonsquamous cell carcinoma
  • Docetaxel, erlotinib, or gefitinib for patients with squamous cell carcinoma
  • Chemotherapy or ceritinib for those with  ALK rearrangement who experience progression after crizotinib

Third-line therapy

  • Treatment with erlotinib for patients who have not received erlotinib or gefitinib.

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