title: Recent issues in first-line treatment of advanced non-small-cell lung cancer: Results of an International Expert Panel Meeting of the Italian Association of Thoracic Oncology.
abstract: Platinum-based chemotherapy is the standard first-line treatment for patients with advanced non-small-cell lung cancer (NSCLC). However, randomized trials have recently demonstrated the efficacy of several new drugs (pemetrexed, bevacizumab, cetuximab, erlotinib, gefitinib) in this setting. Hence, the choice of optimal treatment is no longer limited to the different platinum-based doublets. In order to guide clinical management of patients with advanced NSCLC, assess the strengths and limitations of available evidence, and to suggest priorities for clinical research, the Italian Association of Thoracic Oncology organized an International Expert Panel Meeting on the first-line treatment of advanced NSCLC, which took place in Sperlonga (Italy) in May 2009. Experts recommended that every effort should be made to obtain adequate tumor tissue before initiating treatment. Tumor histology/cytology subtyping is now important for the correct choice of treatment. In particular, considering efficacy data obtained with pemetrexed and safety concerns with bevacizumab, a division between squamous and non-squamous tumors is necessary. Epidermal growth factor receptor (EGFR) mutation analysis, at present, is not recommended in all patients, but should be performed in subgroups of patients characterized by higher prevalence of sensitizing mutations (Asians, never smokers, women, adenocarcinoma). When a mutation is present, first-line treatment with single-agent EGFR tyrosine-kinase inhibitor may be considered. Finally, the potential benefit of maintenance treatment for patients without progression at the end of first-line should be carefully discussed with each patient. Although the number of treatment options for patients with advanced NSCLC has increased recently, their results remain modest and further research is mandatory.
authors.affiliation: Medical Oncology, S.G. Moscati Hospital, Avellino, Italy. cgridelli@libero.it
authors.forename: Cesare
authors.initials: C
authors.lastname: Gridelli
authors.forename: Andrea
authors.initials: A
authors.lastname: Ardizzoni
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Douillard
authors.forename: Nasser
authors.initials: N
authors.lastname: Hanna
authors.forename: Christian
authors.initials: C
authors.lastname: Manegold
authors.forename: Francesco
authors.initials: F
authors.lastname: Perrone
authors.forename: Robert
authors.initials: R
authors.lastname: Pirker
authors.forename: Rafael
authors.initials: R
authors.lastname: Rosell
authors.forename: Frances A
authors.initials: FA
authors.lastname: Shepherd
authors.forename: Luigi
authors.initials: L
authors.lastname: De Petris
authors.forename: Massimo
authors.initials: M
authors.lastname: Di Maio
authors.forename: Filippo
authors.initials: F
authors.lastname: de Marinis
mesh_terms: D000818:Animals; D006801:Humans; D035843:Biomedical Research; D001706:Biopsy; D002289:Carcinoma, Non-Small-Cell Lung / Q000175:diagnosis / Q000276:immunology / Q000473:pathology / Q000628:therapy; D066246:ErbB Receptors / Q000037:antagonists & inhibitors; D006126:Group Processes; D007167:Immunotherapy; D008175:Lung Neoplasms / Q000175:diagnosis / Q000276:immunology / Q000473:pathology / Q000628:therapy; D008495:Medical Oncology; D017671:Platinum Compounds / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D057285:Precision Medicine; D012955:Societies, Medical
chemical_list: C512478:EGFR protein, human; D066246:ErbB Receptors; D017671:Platinum Compounds