Systemic therapy for advanced or metastatic non-small cell lung cancer NCCN2017 Second Edition

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SYSTEMIC THERAPY FOR OR METASTATIC ADVANCED systemic therapy for advanced or metastatic disease, DISEASEADVANCED DISEASE: advanced disease:*

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SYSTEMIC THERAPY FOR OR METASTATIC ADVANCED systemic therapy for advanced or metastatic disease, DISEASE

ADVANCED DISEASE: advanced disease:

* The drug regimen with the highest likelihood of benefit with toxicity deemed acceptable to both the physician and the the initial treatment of patient should be given as initial therapy for advanced lung cancer. * should be most likely to benefit and toxicity for both doctors and patients can take the drug regimen as advanced lung cancer.

* Stage, weight loss, performance status, and gender survival. predict * staging, weight loss, functional status, and gender prediction survival.

* Platinum-based chemotherapy prolongs survival, improves symptom control, and yields superior quality of life compared to best supportive care. * when compared with best supportive care, platinum based chemotherapy to prolong survival and improve symptom control rate and can obtain a better quality of life.

* Histology NSCLC is in the selection systemic therapy. * is important in the selection of systemic therapy in non-small cell lung cancer histology in, China (of) important.

* New agent/platinum combinations have generated a plateau in overall response (rate = 25% - 35%), time to progression (4 - 6 mo), median survival (8 - 10 mo), 1-year survival rate (30% - 40%), and 2-year survival rate (10% - 15%) in it patients. * * / patients receiving drugs the effect of Pt two has a platform: the total efficiency (= 25% - 35%), time to progression (4 - 6 months), the median survival period (8 - 10 months), the 1 year survival rate (30% - 40%), the 2 year survival rate (10% - 15%).

* Unit patients of any age (performance status 3 - 4) do not benefit from cytotoxic treatment, except erlotinib, afatinib or, gefitinib for EGFR mutation-positive and crizotinib for ALK-positive tumors of nonsquamous NSCLC or NSCLC NOS. *PS 3 - 4, of any age, patients do not benefit from cytotoxic therapy, in addition to erlotinib afatinib, or gefitinib for the treatment of EGFR mutation positive and crizotinib for treatment of ALK positive tumors of non squamous non-small cell lung cancer or non-small cell lung cancer unspecified.

First-line Therapy first-line treatment

* There is superior efficacy and reduced toxicity for cisplatin/pemetrexed in patients with nonsquamous histology, in comparison to cisplatin/gemcitabine. * in histological non squamous cell carcinoma, compared with cisplatin / gemcitabine, cisplatin / pemetrexed has superior efficacy and low toxicity.

* There is superior efficacy for cisplatin/gemcitabine in patients with squamous histology, in comparison to cisplatin/pemetrexed. * in the histology of patients with squamous cell carcinoma, compared with cisplatin / pemetrexed, cisplatin / gemcitabine has superior curative effect.

* Two drug regimens are preferred a third cytotoxic drug increases; response rate but not survival. Single-agent therapy may be appropriate in select patients. * two preferred medicine scheme; third cytotoxic drugs to increase efficiency, but does not improve survival. Monotherapy may be justified in selected patients.

* Response assessment after 2 cycles then every 2 - 4 cycles with CT of known sites of disease with or without contrast or when clinically indicated. * two cycles to assess the efficacy, then each 2-4 cycle or clinical indications of the known parts of enhanced or unenhanced CT check.

Maintenance Therapy maintenance therapy

* Continuation maintenance refers to the use of at least one of the agents given in first line, beyond 4 - 6 cycles, in the absence of disease progression. Switch maintenance refers to the initiation of a different agent, not included as part of the first-line regimen, in the absence of disease progression after cycles of, 4 - 6 initial therapy. * to maintain treatment is no progress in the 4 to 6 period after the disease, drug use at least one of the forefront. Switching maintenance therapy is defined as a different drug that is not included in the first-line regimen after the initial treatment of 4-6 cycles.

Subsequent Therapy follow-up treatment

* Response of known sites disease with without every 6 - 12 weeks. * of every 6-12 weeks for known lesion site enhancement or plain assessment scan to assess efficacy of CT examination in, contrast or.

See First-line Systemic Therapy Options for Adenocarcinoma, Large cell, NSCLC NOS on NSCL-F (2 of 4) NSCL-F (2/4) adenocarcinoma, large cell carcinoma, unspecified non-small cell lung cancer first-line systemic therapy.

See Systemic Therapy Options Squamous Carcinoma on NSCL-F Cell (3 of 4) to see NSCL-F (3/4) squamous cell carcinoma of the first line systemic treatment plan in

First-line Systemic Therapy Options first line systemic treatment program

Adenocarcinoma, Large Cell, NSCLC NOS (PS 0-1) adenocarcinoma, large cell lung cancer, non-small cell lung cancer unspecified (PS 0-1)

Bevacizumab/carboplatin/paclitaxel * (category * 1) / bevacizumab carboplatin / paclitaxel (1)

* Bevacizumab/carboplatin/pemetrexed * / bevacizumab carboplatin / pemetrexed

* Bevacizumab/cisplatin/pemetrexed * bevacizumab / cisplatin / pemetrexed

* Carboplatin/albumin-bound paclitaxel (Category 1) * / carboplatin albumin bound paclitaxel (1)

* Carboplatin/docetaxel (Category 1) * carboplatin / docetaxel (Class 1)

* Carboplatin/etoposide (Category 1) * carboplatin / etoposide (Class 1)

* Carboplatin/gemcitabine (Category 1) * carboplatin / gemcitabine (1)

* Carboplatin/paclitaxel (Category 1) * carboplatin / paclitaxel (1)

* Carboplatin/pemetrexed (Category 1) * carboplatin / pemetrexed (1)

Cisplatin/docetaxel * (category * 1) cisplatin / docetaxel (Class 1)

Cisplatin/etoposide * (category * 1) cisplatin / etoposide (Class 1)

* Cisplatin/gemcitabine (Category 1) * cisplatin / gemcitabine (Class 1)

* Cisplatin/paclitaxel (Category 1) * cisplatin / paclitaxel (Class 1)

* Cisplatin/pemetrexed (Category 1) * cisplatin / pemetrexed (Class 1)

* Gemcitabine/docetaxel (Category 1) * / gemcitabine docetaxel (Class 1)

* Gemcitabine/vinorelbine (Category 1) * gemcitabine / Changchun shore (Class 1)

Adenocarcinoma, Large Cell, NSCLC NOS (PS 2) adenocarcinoma, large cell lung cancer, non-small cell lung cancer unspecified (PS 2)

* Albumin-bound paclitaxel * albumin bound paclitaxel

* Carboplatin/albumin-bound paclitaxel * / carboplatin albumin bound paclitaxel

* Carboplatin/docetaxel * / docetaxel carboplatin

* Carboplatin/etoposide * carboplatin / etoposide

* Carboplatin/gemcitabine * / gemcitabine carboplatin

* Carboplatin/paclitaxel * carboplatin / paclitaxel

* Carboplatin/pemetrexed * / pemetrexed carboplatin

* * Docetaxel docetaxel

* Gemcitabine * gemcitabine

* Gemcitabine/docetaxel * / docetaxel gemcitabine

* Gemcitabine/vinorelbine * gemcitabine / Changchun shore

* Paclitaxel * paclitaxel

* Pemetrexed * pemetrexed

Paclitaxel may be substituted + Albumin-bound for either paclitaxel or docetaxel in patients who have experienced hypersensitivity reactions after receiving paclitaxel or docetaxel despite premedication, or for patients where the standard premedications (ie, dexamethasone, H2 blockers, H1 blockers) are contraindicated. + in paclitaxel or docetaxel patients, despite pretreatment still have allergy medication the reaction, or standard pretreatment medication (i.e., dexamethasone, H2 blockers, H1 blockers taboo), albumin bound paclitaxel can replace paclitaxel or docetaxel.

* Bevacizumab should be given until progression. * should be given bevacizumab until disease progression.

Regimen with a high risk * * Any of thrombocytopenia and the potential risk of bleeding should be used with caution in combination with bevacizumab. * * any with thrombocytopenia and potential high-risk bleeding risk plan, bevacizumab should be cautious.

For treatment with bevacizumab: non-squamous * * * Criteria NSCLC, and no recent history of hemoptysis. Bevacizumab should not be given as a single agent, unless as maintenance if initially used with chemotherapy. * * * bevacizumab is a standard therapy for non-small cell lung cancer: and no recent history of hemoptysis. Bevacizumab monotherapy should not be given, unless the initial chemotherapy is then used as maintenance.

First-line Systemic Therapy Options first line systemic treatment program

Squamous Cell Carcinoma (PS 0-1) squamous cell carcinoma (PS 0-1)

* Carboplatin/albumin-bound paclitaxel (Category 1) * / carboplatin albumin bound paclitaxel (1)

* Carboplatin/docetaxel (Category 1) * carboplatin / docetaxel (Class 1)

* Carboplatin/gemcitabine (Category 1) * carboplatin / gemcitabine (1)

* Carboplatin/paclitaxel (Category 1) * carboplatin / paclitaxel (1)

Cisplatin/docetaxel * (category * 1) cisplatin / docetaxel (Class 1)

Cisplatin/etoposide * (category * 1) cisplatin / etoposide (Class 1)

* Cisplatin/gemcitabine (Category 1) * cisplatin / gemcitabine (Class 1)

* Cisplatin/paclitaxel (Category 1) * cisplatin / paclitaxel (Class 1)

* Gemcitabine/docetaxel (Category 1) * / gemcitabine docetaxel (Class 1)

* Gemcitabine/vinorelbine (Category 1) * gemcitabine / Changchun shore (Class 1)

Squamous Cell Carcinoma (PS 2) squamous cell carcinoma (PS 2)

* Albumin-bound paclitaxel * albumin bound paclitaxel

* Carboplatin/albumin-bound paclitaxel * / carboplatin albumin bound paclitaxel

* Carboplatin/docetaxel * / docetaxel carboplatin

* Carboplatin/etoposide * carboplatin / etoposide

* Carboplatin/gemcitabine * / gemcitabine carboplatin

* Carboplatin/paclitaxel * carboplatin / paclitaxel

* * Docetaxel docetaxel

* Gemcitabine * gemcitabine

* Gemcitabine/docetaxel * / docetaxel gemcitabine

* Gemcitabine/vinorelbine * gemcitabine / Changchun shore

* Paclitaxel * paclitaxel

Paclitaxel may be substituted + Albumin-bound for either paclitaxel or docetaxel in patients who have experienced hypersensitivity reactions after receiving paclitaxel or docetaxel despite premedication, or for patients where the standard premedications (ie, dexamethasone, H2 blockers, H1 blockers) are contraindicated. + in paclitaxel or docetaxel patients, despite pretreatment still have allergy medication the reaction, or standard pretreatment medication (i.e., dexamethasone, H2 blockers, H1 blockers taboo), albumin bound paclitaxel can replace paclitaxel or docetaxel.

Cisplatin/gemcitabine/necitumumab in the first-line setting and + erlotinib or afatinib in the second-line setting are not used at NCCN institutions for these indications related to the efficacy and safety of these agents compared to the efficacy and safety of other available agents. in NCCN + + mechanism for these indications, efficacy and safety of these drugs and the efficacy and safety of the other available drugs based on the comparison of cisplatin / gemcitabine /necitumumab for first-line erlotinib, or afatinib is not used for second tier.

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