Metastatic non-small-cell lung cancer (NSCLC): ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up

Reck, Martin; Popat, Saurin R.; Reinmuth, Niels; Ruysscher, Dirk De; Kerr, Keith M.; Peters, Solange

doi:10.1093/annonc/mds226

Cited by 645 publications

(316 citation statements)

References 54 publications

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“…Consensus European guidelines at the time of our study eligibility period (2011 to mid‐2014) recommended the histological sub‐classification of NSCLC, together with EGFR testing and, beginning in 2012, ALK testing, for patients with non‐squamous NSCLC and for light or never‐smokers with squamous NSCLC (Besse et al., 2014; Felip, Gridelli, Baas, Rosell, & Stahel, 2011; Kerr et al., 2014; Peters et al., 2012). For first‐line therapy of metastatic NSCLC, guidelines recommended platinum‐based chemotherapy, four to six cycles; while, for patients with EGFR ‐positive tumours, the recommendation was for an EGFR TKI as first‐line therapy or as maintenance therapy, if not received as first line.…”

Section: Discussionmentioning

confidence: 99%

Systemic therapy treatment patterns in patients with advanced non-small cell lung cancer (NSCLC): PIvOTAL study

et al. 2017

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The aim of this multinational retrospective cohort study, conducted at academic and community oncology centres, was to describe real‐world treatment patterns for patients with a confirmed diagnosis of advanced/metastatic (stage IIIB/IV) non‐small cell lung cancer (NSCLC) who initiated first‐line systemic therapy from January 2011 through June 2014. The study included 1265 patients in Italy, Spain, Germany, Australia, Korea, Taiwan and Brazil. The proportion of patients with squamous versus non‐squamous NSCLC was approximately 20% versus 75%, and associated patient demographic characteristics were similar in all countries, excepting race. Patients with squamous NSCLC were predominantly male and current/ex‐smokers. Biomarker tests were performed for the majority of patients with non‐squamous NSCLC, ranging from 54% (Brazil) to 91% in Taiwan, where, of those tested, 68% with non‐squamous NSCLC had positive epidermal growth factor receptor (EGFR)‐mutation status; in other countries the EGFR‐positive percentages ranged from 17% (Spain/Brazil) to 40% (Korea). Platinum‐based regimens were the most common first‐line therapy in all countries except Taiwan, where gefitinib was the most common first‐line agent. Median overall survival ranged from 9.3 months (Brazil) to 25.5 months (Taiwan). The diagnostic and treatment patterns recorded in this study were heterogeneous but largely in line with NSCLC guidelines during the study period.

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Section: Discussionmentioning

confidence: 99%

Systemic therapy treatment patterns in patients with advanced non-small cell lung cancer (NSCLC): PIvOTAL study

et al. 2017

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“…This differential efficacy based on histology, as well as a significant treatment-by-histology interaction for pemetrexed, was consistently detected across multiple studies [6]. These results led to a recommendation of pemetrexed-cisplatin for first-line treatment of patients with advanced nonsquamous NSCLC [2], [3] and [4].…”

Section: Introductionmentioning

confidence: 89%

“…Platinum-based doublet therapy is recommended for first-line treatment of patients with advanced NSCLC, with cisplatin preferred to carboplatin in Europe [2], [3] and [4]. In a large phase III study of pemetrexed-cisplatin versus gemcitabine-cisplatin, in patients with advanced NSCLC of all histologies (referred to here as "JMDB study"), a pre-specified subgroup analysis in patients with nonsquamous NSCLC showed pemetrexed-cisplatin to have superior survival compared with gemcitabine-cisplatin [5].…”

Section: Introductionmentioning

confidence: 99%

“…More recently, the PARAMOUNT study examined pemetrexed continuation maintenance therapy following four cycles of pemetrexed-cisplatin as induction treatment and found significantly improved PFS and OS when administered to non-progressing patients with advanced, nonsquamous NSCLC [8] and [9]. Current guidelines recommend maintenance single-agent pemetrexed for patients with stable disease (SD) or tumor response after four cycles of platinum-containing induction therapy [2], [3] and [4].…”

Section: Introductionmentioning

confidence: 99%

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Efficacy and safety of maintenance pemetrexed in patients with advanced nonsquamous non-small cell lung cancer following pemetrexed plus cisplatin induction treatment: A cross-trial comparison of two phase III trials

et al. 2014

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Highlights•Compared advanced NSCLC phase III trials: pemetrexed-cisplatin with or without pem maintenance.•4 cycles pem-cis followed by pem maintenance improves survival over 6 cycles pem-cis.•Longer exposure to pem-cis or maintenance pem increases some toxicities, but overall incidence low. Abstract ObjectivesTwo phase III trials of advanced NSCLC patients were compared to examine relative efficacy and safety of differing treatment regimens. The JMDB trial investigated first-line pemetrexed-cisplatin (pemetrexed 500 mg/m 2 plus cisplatin 75 mg/m 2 every 21 days; maximum: 6 cycles). The PARAMOUNT phase III trial compared maintenance pemetrexed versus placebo after patients with nonsquamous NSCLC completed 4 cycles of first-line pemetrexed-cisplatin without disease progression. MethodsOverall survival (OS) and progression-free survival (PFS), analyzed by Kaplan-Meier and Cox methods, and toxicity rates were compared between the PARAMOUNT arms and a selected homogeneous population from JMDB: 346 patients with disease and prior treatment characteristics matching the PARAMOUNT population. ResultsOutcomes for the PARAMOUNT placebo arm were similar to the JMDB homogeneous group (median PFS: 5.6 versus 6.2 months, p = 0.117, HR = 1.16; median OS: 14.0 versus 14.2 months, p = 0.979, HR = 1.00). The PARAMOUNT maintenance pemetrexed group had statistically superior efficacy compared with the JMDB homogeneous group (median PFS: 7.5 versus 6.2 months, p < 0.00001, HR = 0.66; median OS: 16.9 versus 14.2 months, p = 0.003, HR = 0.75). Patients who received pemetrexed maintenance (median 4 cycles, range 1-44) following 4 cycles of pemetrexed-cisplatin exhibited a higher incidence of drug-related serious adverse events compared with JMDB patients (median 6 cycles of pemetrexed-cisplatin) (10.6% versus 2.9%); grade 3/4 fatigue and renal toxicity were also higher in the pemetrexed arm of PARAMOUNT. ConclusionsThe across-trial comparison of a relevant JMDB study population with the two arms of the PARAMOUNT study supported the efficacy of the pemetrexed continuation maintenance strategy and suggested the results are not influenced by limiting the pemetrexed-cisplatin induction treatment to four cycles. Although longer exposure to pemetrexed-cisplatin or maintenance pemetrexed increased some toxicities, the overall incidence remained low, underscoring the relative safety of these treatment regimens.

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“…Whereas single agent chemotherapy is still recommended as the best option in the first-line treatment of PS 2 patients, platinum-based combination is considered as a possible alternative [6]; so the best treatment of these subset of patients is still uncertain and debated. PS 2 patients represent a significant proportion of the advanced NSCLC population (up of 30-40% of cases), even if the exact prevalence is still not certain [7,8].…”

Section: Introductionmentioning

confidence: 99%

What can platinum offer yet in the treatment of PS2 NSCLC patients? A systematic review and meta-analysis

Bronte

Rolfo

Passiglia

et al. 2015

Critical Reviews in Oncology/Hematology

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Metastatic non-small-cell lung cancer (NSCLC): ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up

Cited by 645 publications

References 54 publications

Systemic therapy treatment patterns in patients with advanced non-small cell lung cancer (NSCLC): PIvOTAL study

Systemic therapy treatment patterns in patients with advanced non-small cell lung cancer (NSCLC): PIvOTAL study

Efficacy and safety of maintenance pemetrexed in patients with advanced nonsquamous non-small cell lung cancer following pemetrexed plus cisplatin induction treatment: A cross-trial comparison of two phase III trials

What can platinum offer yet in the treatment of PS2 NSCLC patients? A systematic review and meta-analysis

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