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American Society of Clinical Oncology Clinical Practice Guideline Update on Chemotherapy for Stage IV Non–Small-Cell Lung Cancer
Open accessAbstract
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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“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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Wachters, F. M., van Putten, J. W. G., Kramer, H., Erjavec, Z., Eppinga, P., Strijbos, J. H., de Leede, G. P. J., Boezen, H. M., de Vries, E. G. E., & Groen, H. J. M. (2003) · British Journal of Cancer · doi:10.1038/sj.bjc.6601283 · Cited by 61
Stathopoulos, G. P., Veslemes, M., Georgatou, N., Antoniou, D., Giamboudakis, P., Katis, K., Tsavdaridis, D., Rigatos, S. K., Dimitroulis, J., Bastani, S., et al. (2004) · Annals of Oncology · doi:10.1093/annonc/mdh260 · Cited by 60
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Flagged first, then by citations
2 of the 218 references couldn’t be matched to a known paper.
Research works printed but not linked: 7
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Sorted by citations
Travis, W. D., Brambilla, E. M., Noguchi, M., Nicholson, A. G., Geisinger, K. R., Yatabe, Y., Beer, D. G., Powell, C. A., Riely, G. J., Schil, P. E. V., et al. (2011) · Journal of Thoracic Oncology · doi:10.1097/jto.0b013e318206a221 · Cited by 4,834
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Metadata
- 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
- Venue
- Journal of Clinical Oncology
- Published
- 2009-12-20
- Volume
- 27
- Issue
- 36
- Pages
- 6251-6266
- ISSN
- 0732-183X (ISSN-L)
- 1527-7755
- 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
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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