title: 2011 Focused Update of 2009 American Society of Clinical Oncology Clinical Practice Guideline Update on Chemotherapy for Stage IV Non-Small-Cell Lung Cancer.
abstract: OBJECTIVE
  An American Society of Clinical Oncology (ASCO) focused update updates a single recommendation (or subset of recommendations) in advance of a regularly scheduled guideline update. This document updates one recommendation of the ASCO Guideline Update on Chemotherapy for Stage IV Non-Small-Cell Lung Cancer (NSCLC) regarding switch maintenance chemotherapy.
  
  
  METHODS
  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. Because of limitations in the data, delayed treatment with a second-line agent after disease progression is also acceptable.
  
  
  METHODS
  Seven randomized controlled trials of carboxyaminoimidazole, docetaxel, erlotinib, gefitinib, gemcitabine, and pemetrexed have evaluated outcomes in patients who received an immediate, non-cross resistant alternative therapy (switch maintenance) after first-line therapy.
  
  
  CONCLUSIONS
  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 stable but not responding to treatment. Two-drug cytotoxic combinations should be administered for no more than six cycles. For those 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.
authors: Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
authors: Christopher G
authors: CG
authors: Azzoli
authors: Sarah
authors: S
authors: Temin
authors: Timothy
authors: T
authors: Aliff
authors: Sherman
authors: S
authors: Baker
authors: Julie
authors: J
authors: Brahmer
authors: David H
authors: DH
authors: Johnson
authors: Janessa L
authors: JL
authors: Laskin
authors: Gregory
authors: G
authors: Masters
authors: Daniel
authors: D
authors: Milton
authors: Luke
authors: L
authors: Nordquist
authors: William
authors: W
authors: Pao
authors: David G
authors: DG
authors: Pfister
authors: Steven
authors: S
authors: Piantadosi
authors: Joan H
authors: JH
authors: Schiller
authors: Reily
authors: R
authors: Smith
authors: Thomas J
authors: TJ
authors: Smith
authors: John R
authors: JR
authors: Strawn
authors: David
authors: D
authors: Trent
authors: Giuseppe
authors: G
authors: Giaccone
mesh_terms: D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000473:pathology; D017326:Clinical Trials, Phase III as Topic; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000473:pathology; D009367:Neoplasm Staging; D016032:Randomized Controlled Trials as Topic