NEW YORK (Reuters Health) Sep 09 - New data have prompted a focused update from the American Society of Clinical Oncology (ASCO) of one recommendation from its 2009 Clinical Practice Guideline on Chemotherapy for Stage IV Non-Small-Cell Lung Cancer (NSCLC).
The update deals with "switch maintenance chemotherapy" - administering alternative therapy to patients who have undergone first-line therapy for specified number of cycles (usually four to six) and experienced response or achieved stable disease.
The update was published online September 6 in the Journal of Clinical Oncology.
It states, "Recent results from phase III clinical trials have demonstrated that in patients with stage IV NSCLC who have received four cycles of first-line chemotherapy and whose disease has not progressed, an immediate switch to alternative, single-agent chemotherapy can extend progression-free survival and, in some cases, overall survival."
However, due to limitations in the data, delayed treatment with a second-line agent after disease progression is also acceptable, the report states.
The NSCLC clinical guideline update committee addressed the following clinical question: What is the optimal duration of first-line chemotherapy for stage IV NSCLC?
The 2009 guideline states that in patients with stage IV NSCLC, first-line cytotoxic chemotherapy should be stopped at disease progression or after four cycles in patients whose disease is not responding to treatment.
The 2011 focused update changes the last part of this sentence to "...whose disease is STABLE BUT not responding to treatment." (In a printed summary of the updated guideline, the words "stable but" appear lowercase but in bold.)
The 2009 guideline states that two-drug cytotoxic combinations should be given for no more than six cycles. This statement remains unchanged in the 2011 focused update.
The 2009 guideline also states that for patients who have stable disease or who respond to first-line therapy, evidence does not support continuation of cytotoxic therapy until disease progression or initiation of a different chemotherapy before disease progression.
The 2011 focused update changes this recommendation to the following (again, changes are in all caps): For patients with stable disease OR RESPONSE AFTER FOUR CYCLES, IMMEDIATE TREATMENT WITH AN ALTERNATIVE, SINGLE-AGENT CHEMOTHERAPY SUCH AS PEMETREXED IN PATIENTS WITH NONSQUAMOUS HISTOLOGY, DOCETAXEL IN UNSELECTED PATIENTS, OR ERLOTINIB IN UNSELECTED PATIENTS MAY BE CONSIDERED; LIMITATIONS OF THIS DATA ARE SUCH THAT A BREAK FROM CYTOTOXIC CHEMOTHERAPY AFTER A FIXED COURSE IS ALSO ACCEPTABLE, WITH INITIATION OF SECOND-LINE CHEMOTHERAPY AT DISEASE PROGRESSION.
No other changes have been made to the 2009 ASCO clinical practice guideline on chemotherapy for stage IV NSCLC.
The 2009 guideline, a link to the update, data supplements and clinical tools can be found at http://www.asco.org/guidelines/NSCLC.
SOURCE: http://bit.ly/rdWhpX
J Clin Oncol 2011.
The update deals with "switch maintenance chemotherapy" - administering alternative therapy to patients who have undergone first-line therapy for specified number of cycles (usually four to six) and experienced response or achieved stable disease.
The update was published online September 6 in the Journal of Clinical Oncology.
It states, "Recent results from phase III clinical trials have demonstrated that in patients with stage IV NSCLC who have received four cycles of first-line chemotherapy and whose disease has not progressed, an immediate switch to alternative, single-agent chemotherapy can extend progression-free survival and, in some cases, overall survival."
However, due to limitations in the data, delayed treatment with a second-line agent after disease progression is also acceptable, the report states.
The NSCLC clinical guideline update committee addressed the following clinical question: What is the optimal duration of first-line chemotherapy for stage IV NSCLC?
The 2009 guideline states that in patients with stage IV NSCLC, first-line cytotoxic chemotherapy should be stopped at disease progression or after four cycles in patients whose disease is not responding to treatment.
The 2011 focused update changes the last part of this sentence to "...whose disease is STABLE BUT not responding to treatment." (In a printed summary of the updated guideline, the words "stable but" appear lowercase but in bold.)
The 2009 guideline states that two-drug cytotoxic combinations should be given for no more than six cycles. This statement remains unchanged in the 2011 focused update.
The 2009 guideline also states that for patients who have stable disease or who respond to first-line therapy, evidence does not support continuation of cytotoxic therapy until disease progression or initiation of a different chemotherapy before disease progression.
The 2011 focused update changes this recommendation to the following (again, changes are in all caps): For patients with stable disease OR RESPONSE AFTER FOUR CYCLES, IMMEDIATE TREATMENT WITH AN ALTERNATIVE, SINGLE-AGENT CHEMOTHERAPY SUCH AS PEMETREXED IN PATIENTS WITH NONSQUAMOUS HISTOLOGY, DOCETAXEL IN UNSELECTED PATIENTS, OR ERLOTINIB IN UNSELECTED PATIENTS MAY BE CONSIDERED; LIMITATIONS OF THIS DATA ARE SUCH THAT A BREAK FROM CYTOTOXIC CHEMOTHERAPY AFTER A FIXED COURSE IS ALSO ACCEPTABLE, WITH INITIATION OF SECOND-LINE CHEMOTHERAPY AT DISEASE PROGRESSION.
No other changes have been made to the 2009 ASCO clinical practice guideline on chemotherapy for stage IV NSCLC.
The 2009 guideline, a link to the update, data supplements and clinical tools can be found at http://www.asco.org/guidelines/NSCLC.
SOURCE: http://bit.ly/rdWhpX
J Clin Oncol 2011.
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