American Society of Clinical Oncology Clinical Practice Guideline Update on Chemotherapy for Stage IV Non–Small-Cell Lung Cancer

Azzoli, Christopher G.; Baker, Sherman; Temin, Sarah; Pao, William; Aliff, Timothy; Brahmer, Julie; Johnson, David H.; Laskin, Janessa L.; Masters, Gregory; Milton, Daniel; Nordquist, Luke; Pfister, David G.; Piantadosi, Steven; Schiller, Joan H.; Smith, Reily; Smith, Thomas J.; Strawn, John R.; Trent, David; Giaccone, Giuseppe

doi:10.1200/jco.2009.23.5622

Cited by 915Lung Cancer Treatments and MutationsLung Cancer Diagnosis and TreatmentLung Cancer Research Studies

American Society of Clinical Oncology Clinical Practice Guideline Update on Chemotherapy for Stage IV Non–Small-Cell Lung Cancer

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Azzoli, Christopher G., Baker, Sherman, Temin, Sarah, Pao, William, Aliff, Timothy, Brahmer, Julie, Johnson, David H., Laskin, Janessa L. +11 more·2009·Journal of Clinical Oncology

DOI 10.1200/jco.2009.23.5622PMC PMC2793036

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Abstract

The purpose of this article is to provide updated recommendations for the treatment of patients with stage IV non-small-cell lung cancer. A literature search identified relevant randomized trials published since 2002. The scope of the guideline was narrowed to chemotherapy and biologic therapy. An Update Committee reviewed the literature and made updated recommendations. One hundred sixty-two publications met the inclusion criteria. Recommendations were based on treatment strategies that improve overall survival. Treatments that improve only progression-free survival prompted scrutiny of toxicity and quality of life. For first-line therapy in patients with performance status of 0 or 1, a platinum-based two-drug combination of cytotoxic drugs is recommended. Nonplatinum cytotoxic doublets are acceptable for patients with contraindications to platinum therapy. For patients with performance status of 2, a single cytotoxic drug is sufficient. Stop first-line cytotoxic chemotherapy at disease progression or after four cycles in patients who are not responding to treatment. Stop two-drug cytotoxic chemotherapy at six cycles even in patients who are responding to therapy. The first-line use of gefitinib may be recommended for patients with known epidermal growth factor receptor (EGFR) mutation; for negative or unknown EGFR mutation status, cytotoxic chemotherapy is preferred. Bevacizumab is recommended with carboplatin-paclitaxel, except for patients with certain clinical characteristics. Cetuximab is recommended with cisplatin-vinorelbine for patients with EGFR-positive tumors by immunohistochemistry. Docetaxel, erlotinib, gefitinib, or pemetrexed is recommended as second-line therapy. Erlotinib is recommended as third-line therapy for patients who have not received prior erlotinib or gefitinib. Data are insufficient to recommend the routine third-line use of cytotoxic drugs. Data are insufficient to recommend routine use of molecular markers to select chemotherapy.

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Multiple trials did not identify age as a pretreatment risk factor for either tolerance or response to treatment with cytotoxic therapy.
“However, multiple trials did not identify age as a pretreatment risk factor for either tolerance or response to treatment with cytotoxic therapy.1”
From Systemic Therapy for Stage IV Non–Small-Cell Lung Cancer: American Society of Clinical Oncology Clinical Practice Guideline Update (2015) · cites this paper as [1]

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Tislelizumab Plus Chemotherapy vs Chemotherapy Alone as First-line Treatment for Advanced Squamous Non–Small-Cell Lung Cancer: A Phase 3 Randomized Clinical Trial
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Consensus for EGFR Mutation Testing in Non-small Cell Lung Cancer: Results from a European Workshop
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Biomarkers That Currently Affect Clinical Practice in Lung Cancer: EGFR, ALK, MET, ROS-1, and KRAS
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Authors: Azzoli, C. G., Baker, S., Temin, S., Pao, W., Aliff, T., Brahmer, J., Johnson, D. H., Laskin, J. L., Masters, G., Milton, D., Nordquist, L., Pfister, D. G., Piantadosi, S., Schiller, J. H., Smith, R., Smith, T. J., Strawn, J. R., Trent, D., & Giaccone, G.
Affiliations: American Society of Clinical Oncology (US)
ORCID: Azzoli, Christopher G.
Temin, Sarah
Pao, William
Brahmer, Julie
Johnson, David H.
Masters, Gregory
Pfister, David G.
Piantadosi, Steven
Schiller, Joan H.
Smith, Thomas J.
Giaccone, Giuseppe
Venue: Journal of Clinical Oncology
Publisher: American Society of Clinical Oncology (ASCO)
Published: 2009-12-20
Volume: 27
Issue: 36
Pages: 6251-6266
ISSN: 0732-183X (ISSN-L)
1527-7755
DOI: 10.1200/jco.2009.23.5622
PMC: PMC2793036
OpenAlex: W2119366998
Cited by: 915
References: 218
Citations by year: 2026: 6 · 2025: 4 · 2024: 9 · 2023: 8 · 2022: 12 · 2021: 25 · 2020: 21 · 2019: 33 · 2018: 38 · 2017: 38 · 2016: 67 · 2015: 89 · 2014: 111 · 2013: 128 · 2012: 119
FWCI: 90.05
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Locations: Journal of Clinical Oncology (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Lung Cancer Treatments and Mutations
Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Lung Cancer Diagnosis and Treatment
Health Sciences › Medicine › Oncology › Lung Cancer Research Studies
Keywords: stage IV non-small cell lung cancer, chemotherapy, first-line therapy, second-line therapy, third-line therapy, gefitinib, erlotinib, bevacizumab, carboplatin-paclitaxel, cetuximab, docetaxel, EGFR mutation, platinum-based doublets, overall survival, progression-free survival, treatment toxicity
MeSH terms: Carcinoma, Non-Small-Cell Lung, Humans, Lung Neoplasms, Neoplasm Staging

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American Society of Clinical Oncology Clinical Practice Guideline Update on Chemotherapy for Stage IV Non–Small-Cell Lung Cancer

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