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ASCO Releases Updated Treatment Guidelines For Patients With Stage 4 Non-Small Cell Lung Cancer

Main Category: Lung Cancer
Also Included In: Cancer / Oncology
Article Date: 17 Nov 2009

New recommendations on the use of chemotherapy to treat patients with stage 4 non-small cell lung cancer (NSCLC) were issued today by the American Society of Clinical Oncology (ASCO).

The evidence-based clinical practice guideline indicates a patient's physical age should not determine the cancer treatment he/she is given. Instead, ASCO recommends oncologists take other factors into account including physiological age and performance status when determining appropriate treatment for stage 4 NSCLC patients.

The new guideline also makes specific recommendations for first-line treatment of NSCLC including:

- Cisplatin (Platinol) or carboplatin (Paraplatin) may be used for first-line chemotherapy in combination with a second drug, such as docetaxel (Taxotere), gemcitabine (Gemzar), irinotecan (Camptosar), paclitaxel (Taxol), pemetrexed (Alimta) or vinorelbine (Navelbine).

- Bevacizumab (Avastin) is recommended with carboplatin plus paclitaxel in particular circumstances.

- Physicians may consider adding cetuximab (Erbitux) to cisplatin plus vinorelbine in first-line therapy in patients with a tumor which tests positive for EGFR protein.

- Gefitinib (Iressa) may be used as first-line therapy in patients with a tumor which tests positive for an activating EGFR gene mutation.

Recommendations for second-line and third-line treatment include:

- For second-line treatment, the guideline recommends the use of a single drug, eitherdocetaxel, erlotinib, gefitinib or pemetrexed.

- For third-line treatment, the guideline recommends erlotinib if a patient's performance status is 0 to 3 and he/she has not previously received erlotinib or gefitinib.

While patients with a tumor that tests positive for an EGFR mutation may receive certain drugs which target EGFR earlier in the course of their disease, the guideline does not recommend the routine use of molecular markers to choose treatment for patients with NSCLC because there is not enough evidence that doing so extends patients' lives.

"The use of molecular markers in treating people with cancer is a rapidly developing field with interesting potential," said Giuseppe Giaccone, MD, PhD, co-chair of the guideline expert panel and a physician and researcher with the National Cancer Institute. "ASCO is diligently monitoring clinical research involving the use of biomarkers to personalize the treatment of patients with NSCLC to ensure that its guidelines reflect all available high quality evidence."

The updated guideline also highlights disparities in treating members of minority populations who are diagnosed with lung cancer. Research has shown that only 36 percent of African Americans with stage 4 NSCLC receive first-line chemotherapy. Reasons for these disparities include socio-economic status, access to health services, other existing medical conditions and ineffectual communication between health care providers and patients.

"Ethnic and racial minorities experience worse outcomes compared to whites in all stages of lung cancer, and these disparities are frequently due to communication barriers between doctors and their patients," said Christopher G. Azzoli, MD, co-lead author of the guideline and physician at the Memorial Sloan-Kettering Cancer Center in New York City. "When patients receive uniform clinical care, these disparities are minimized."

Lung cancer is the leading cause of cancer deaths for men and women in the United States, and it is estimated that 159,390 people will die from lung cancer (88,900 men and 70,490 women) in 2009. NSCLC is the most common type of lung cancer, and a stage 4 diagnosis means that the cancer has spread to the opposite lung, and/or to distant sites within the body by way of the bloodstream and is no longer operable. Once released in the blood, NSCLC can spread anywhere in the body, but has a tendency to spread to the brain, bones, liver, and adrenal glands.

ASCO published its first evidence-based clinical practice guideline on treating NSCLC in 1997 and published an update in 2003. In conjunction with the latest update published today, ASCO has developed clinical tools and resources for oncologists that summarize the findings and recommendations. These resources include Decision Aid Tools to help physicians and patients have a better dialogue on the potential benefits, risks, and prognosis of treating stage 4 non-small cell lung cancer with chemotherapy, as well as a slide presentation and a summary in the Journal of Oncology Practice.

The updated clinical practice guideline, decision aid tools, and other resources are available at http://www.asco.org/guidelines/nsclc. ASCO also has developed a corresponding patient guide available on ASCO's patient web site, http://www.cancer.net.

This guideline is being published in the November 16 issue of the Journal of Clinical Oncology (JCO), the semi-monthly peer-reviewed journal of the American Society of Clinical Oncology (ASCO), the world's leading professional society representing physicians who treat people with cancer.

Source
American Society of Clinical Oncology

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