New Guidelines for Advanced NSCLC

In the most recent update, investigators conducted a literature search for all relevant randomized trials published since 2002, looking specifically for treatment strategies that improved overall survival. Drugs that were found to only improve progression-free survival were evaluated in light of their toxicity and quality-of-life benefits. Several new drugs have entered the market, so it was important to take a fresh look at our first- and second-line therapies. One of the most important additions to first-line treatment for stage IV NSCLC has been the arrival of bevacizumab, which can be used in conjunction with carboplatin-paclitaxel. There have also been new arrivals on the second-line therapy, including pemetrexed and erlotinib. In addition to existing therapies, these new drugs have been evaluated and ranked according to a number of treatment scenarios and the likely benefits that they can confer to patients. According to the evidence, these newer drugs appear to have made an impact on treatment decisions. Clinicians should recognize that it’s important to tailor treatments based on individual characteristics of patients. For example, physical age should no longer be factored into treatment decisions. Instead, patients’ physiological age and performance status are more appropriate benchmarks for deciding on treatments. Additionally, race and genetic makeup appear to impact treatment strategies.  Genes Matter A new aspect of the 2009 ASCO guideline update is the evaluation of genetic biomarkers, which may affect how patients will respond to a particular agent. While there are several biomarkers with evidence supporting an impact on disease progression, none are currently as well-characterized as mutations in the epidermal growth factor receptor (EGFR). When patients have known EGFR mutations, treatment...