Systemic Therapy for Stage IV Non-Small-Cell Lung Cancer: American Society of Clinical Oncology Clinical Practice Guideline Update
Systemic Therapy for Stage IV Non-Small-Cell Lung Cancer: American Society of Clinical Oncology Clinical Practice Guideline Update
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DOI：
10.1200/jco.2015.62.1342
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发表时间：
2015-10-20
影响因子：
45.3
通讯作者：
Johnson, David H.
中科院分区：
文献类型：
--
作者：
Masters, Gregory A.;Temin, Sarah;Johnson, David H.
目的为更新美国临床肿瘤学会关于IV期非小细胞肺癌（NSCLC）全身治疗指南提供循证建议方法美国临床肿瘤学会非小细胞肺癌专家组更新委员会基于2007年1月至2014年2月随机对照试验的系统性综述提出建议。IV期非小细胞肺癌（NSCLC）患者目前尚无法治愈。对于体能状态（PS）为0 - 1（以及适当的PS 2患者病例）且无EGFR致敏突变或ALK基因重排的患者，建议根据组织学指导联合细胞毒性化疗，同时进行早期姑息治疗。对一线患者的建议包括对PS为0至1的患者进行铂双联治疗（如果无禁忌症，贝伐珠单抗可加用卡铂+紫杉醇）; PS 2患者接受联合或单药化疗或单独姑息治疗; EGFR突变致敏患者接受阿法替尼、厄洛替尼或吉非替尼; ALK或ROS 1基因重排患者接受克唑替尼;对于大细胞神经内分泌癌患者，应遵循一线建议或使用铂类联合依托泊苷。维持治疗包括对病情稳定或对含培美曲塞的一线治疗方案有反应的患者继续使用培美曲塞、替代化疗或化疗中断。在二线治疗中，建议非鳞状细胞癌患者使用多西他赛、厄洛替尼、吉非替尼或培美曲塞;鳞状细胞癌患者使用多西他赛、厄洛替尼或吉非替尼;克唑替尼治疗后进展的ALK重排患者使用化疗或色瑞替尼。在三线治疗中，对于未接受厄洛替尼或吉非替尼治疗的患者，推荐使用厄洛替尼治疗。没有足够的数据推荐常规三线细胞毒性治疗。关于全身治疗的决定不应该仅仅基于年龄。更多信息可以在http://www.asco.org/guidelines/nsclc和http://www.asco.org/guidelineswiki上找到。(C)2015年美国临床肿瘤学会
PurposeTo provide evidence-based recommendations to update the American Society of Clinical Oncology guideline on systemic therapy for stage IV non-small-cell lung cancer (NSCLC).MethodsAn Update Committee of the American Society of Clinical Oncology NSCLC Expert Panel based recommendations on a systematic review of randomized controlled trials from January 2007 to February 2014.ResultsThis guideline update reflects changes in evidence since the previous guideline.RecommendationsThere is no cure for patients with stage IV NSCLC. For patients with performance status (PS) 0 to 1 (and appropriate patient cases with PS 2) and without an EGFR-sensitizing mutation or ALK gene rearrangement, combination cytotoxic chemotherapy is recommended, guided by histology, with early concurrent palliative care. Recommendations for patients in the first-line setting include platinum-doublet therapy for those with PS 0 to 1 (bevacizumab may be added to carboplatin plus paclitaxel if no contraindications); combination or single-agent chemotherapy or palliative care alone for those with PS 2; afatinib, erlotinib, or gefitinib for those with sensitizing EGFR mutations; crizotinib for those with ALK or ROS1 gene rearrangement; and following first-line recommendations or using platinum plus etoposide for those with large-cell neuroendocrine carcinoma. Maintenance therapy includes pemetrexed continuation for patients with stable disease or response to first-line pemetrexed-containing regimens, alternative chemotherapy, or a chemotherapy break. In the second-line setting, recommendations include docetaxel, erlotinib, gefitinib, or pemetrexed for patients with nonsquamous cell carcinoma; docetaxel, erlotinib, or gefitinib for those with squamous cell carcinoma; and chemotherapy or ceritinib for those with ALK rearrangement who experience progression after crizotinib. In the third-line setting, for patients who have not received erlotinib or gefitinib, treatment with erlotinib is recommended. There are insufficient data to recommend routine third-line cytotoxic therapy. Decisions regarding systemic therapy should not be made based on age alone. Additional information can be found at http://www.asco.org/guidelines/nsclc and http://www.asco.org/guidelineswiki. (C) 2015 by American Society of Clinical Oncology