The Japanese Lung Cancer Society Guideline for non-small cell lung cancer, stage IV

Abstract

According to rapid development of chemotherapy in advanced non-small cell lung cancer (NSCLC), the Japan Lung Cancer Society has been updated its own guideline annually since 2010. In this latest version, all of the procedure was carried out in accordance with grading of recommendations assessment, development and evaluation (GRADE) system. It includes comprehensive literature search, systematic review, and determination of the recommendation by multidisciplinary expert panel which consisted of medical doctors, pharmacists, nurses, statisticians, and patients from patient advocacy group. Recently, we have had various types of chemotherapeutic drugs like kinase inhibitors or immune-checkpoint inhibitors. Thus, the guideline proposes to categorize patients into three entities: (1) driver oncogene-positive, (2) PD-L1 ≥ 50%, and (3) others. Based on this subgroup, 31 clinical questions were described. We believe that this attempt enables clinicians to choose appropriate treatment easier. Here, we report an English version of the Japan Lung Cancer Society Guidelines 2018 for NSCLC, stages IV.

Antioxidant Supplementation in the Treatment of Neurotoxicity Induced by Platinum-Based Chemotherapeutics—A Review

“…Since 1979 cisplatin has been widely used (along with other antineoplastic drugs) in the treatment of various malignancies: lung [ 3 ], ovarian [ 4 ], testicular [ 5 ], breast [ 6 ] and brain cancer [ 7 ], sarcomas [ 8 ], and lymphomas [ 9 ]. Starting in 1989, carboplatin confirmed clinical relevance as an antineoplastic agent (in combination with other chemotherapeutics) for advanced ovarian carcinoma [ 10 ], head and neck cancer [ 11 ], and lung cancer [ 12 ]. The latest worldwide accepted platinum-based chemotherapeutic (2002), oxaliplatin, is used as a part of the therapeutic protocols for metastatic colorectal cancer [ 13 ], advanced gastric [ 14 ] and ovarian cancer [ 15 ].…”

A Phase II Study of First-line Afatinib For Patients Aged ≥ 75 Years With EGFR Mutation-positive Advanced Non-small Cell Lung Cancer: North East Japan Study Group Trial NEJ027

“…18,26 Moreover, given that kinase inhibitors usually show milder toxicity than cytotoxic chemotherapy, the current Japanese Lung Cancer Society guideline for stage IV NSCLC recommends (level 1C) the use of any EGFR TKI for the rst-line treatment of elderly patients with a driver oncogene. 17 In this regard, afatinib may be a suitable choice for elderly patients with EGFR mutationpositive NSCLC who are receiving multiple concomitant medications, due to its reported low potential for drug-drug interactions, and low exposure to hepatic metabolism and excretion. 28 The interpretation of this analysis should be treated with caution due to limitations, including the singlearm design of the study, and the small numbers of patients investigated overall and in EGFR mutation subgroups.…”

“…1 Carboplatin-based doublet chemotherapy is recommended for eligible patients aged ≥ 70 years with Eastern Cooperative Oncology Group performance status (ECOG PS) of 0-2 and adequate organ function, while single-agent chemotherapy remains the standard of care for patients not eligible for doublet chemotherapy. 1 Asian treatment guidelines also recommend EGFR TKI monotherapy as rst-line treatment for the general population of patients with EGFR mutation-positive NSCLC, 1,17 and there is evidence that EGFR TKIs may be effective for some elderly patients with EGFR mutation-positive NSCLC. 18 Indeed, in a subgroup analysis of the LUX-Lung 3, 6, and 7 studies, afatinib was effective and tolerable in patients with EGFR mutation-positive NSCLC, independent of age at diagnosis.…”

Phase II Study on Biweekly Combination Therapy of Gemcitabine plus Carboplatin for the Treatment of Elderly Patients with Advanced Non-Small Cell Lung Cancer

“…More than 45% of patients with lung cancer are diagnosed at ≥75 years , and this proportion is likely to increase. In patients with advanced NSCLC, chemotherapy improves survival, disease‐related symptoms, and quality of life, and combination chemotherapy involving newer agents is now considered the standard first‐line treatment . However, combination chemotherapy causes increased hematologic and neuropsychiatric toxicity in older patients , and >90% of elderly patients experience grade ≥3 toxicity when treated with platinum‐based combination chemotherapy .…”