What are the ACCP recommendations for treatment of 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

The updated ACCP guidelines recommendations for treatment of clinical stage IV NSCLC include the following [81] :

  • The treatment of stage IV NSCLC should be specific for particular histologic subtypes and clinical patient characteristics and according to the presence of specific genetic mutations.

  • Both erlotinib and gefitinib as first-line therapy in patients with stage IV NSCLC and documented EGFR mutations based on superior response rates, progression-free survival and toxicity profiles compared with platinum-based doublets

  • Pemetrexed should be restricted to patients with nonsquamous histology (adenocarcinoma)

  • Bevacizumab in combination with chemotherapy (and as continuation maintenance) should be restricted to patients with nonsquamous histology and an Eastern Cooperative Oncology Group (ECOG) performance status (PS) of 0 to 1

  • The use of maintenance therapy with either pemetrexed or erlotinib should be considered after four cycles of first-line therapy in those patients without evidence of disease progression

  • The use of second- and third-line therapy is recommended in those patients retaining a good PS (1-2)

  • In the elderly and in patients with a poor PS, the use of two-drug, platinum-based regimens is preferred.

  • Palliative care should be initiated early in the course of therapy for stage IV NSCLC


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