Early palliative care and, in some cases, targeted therapy options should be offered to patients with metastatic non-small cell lung cancer (NSCLC), according to the newly released American Society of Clinical Oncology (ASCO) update to its clinical practice guideline for stage 4 NSCLC.1

“Although there is no cure for patients with stage 4 non-small cell lung cancer, various treatment options are available that can help patients control their cancer longer,” said Gregory Masters, MD, co-chair of the ASCO Expert Panel that promulgated the updated clinical practice guideline.

“This guideline will help doctors choose the most appropriate therapies, depending on the biology of the tumor and the patient’s general well-being.”

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The ASCO Expert Panel conducted a systematic review of 73 phase 3 randomized controlled clinical trials published between January 2007 and February 2014, to update clinical practice guideline for first-, second-, and third-line systemic treatments, including both chemotherapy and targeted therapies.

For first-line treatment, the updated ASCO guideline recommendations state the following:

For tumors that do not harbor EGFR or ALK gene mutations, combination cytotoxic chemotherapy for patients with performance status 0 or 1 is recommended. For patients with performance status 2, chemotherapy or palliative care alone may be used.

If tumor harbor sensitizing EGFR mutations, then afatinib, erlotinib, or gefitinib is recommended. 1

For tumors harboring ALK or ROS1 gene rearrangements, crizotinib is recommended.

For treatment after initial response to first-line treatments, patients “may be recommended to either switch to another regimen, or continue first-line therapy, or take a break from chemotherapy,” the guideline update states.

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“Maintenance therapy can improve outcome if a patient has tolerated first-line therapy and the disease is stabilized or improved,” Dr. Masters told Cancer Therapy Advisor.

“Pemetrexed is often used as continuation maintenance for someone getting pemetrexed and a platinum as first-line therapy and is often well tolerated. If side effects are building up, the patient may need a break, or if their functional status has declined. Erlotinib is also used as maintenance therapy.”