The number of cycles of systemic therapy for recurrent / metastatic non-small cell lung cancer

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Non-Small Cell Lung Cancer non small cell lung cancerNCCN Guidelines Version 4.2016 NCCN guide 2016 edition fourthDiscussion discussionTreat

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Non-Small Cell Lung Cancer non small cell lung cancer

NCCN Guidelines Version 4.2016 NCCN guide 2016 edition fourth

Discussion discussion

Treatment of Treatment of Recurrences Distant and recurrence and distant metastasis in Metastases

Number of Cycles First-Line Systemic Therapy first line systemic treatment cycle number

Patients receiving first-line systemic therapy for advanced disease should be evaluated for tumor response with a CT scan. Approximately patients show disease progression 25% of after the initial cycle of chemotherapy subsequent therapy is recommended for; these patients (see the NCCN Guidelines for Non-Small Cell Lung Cancer Patients with responsive). Or stable disease can continue to receive a total of 4 to 6 cycles of systemic therapy. Currently, the NCCN Guidelines do not recommend continuing chemotherapy beyond 4 to 6 cycles. receiving first-line systemic therapy in patients with advanced disease using CT scan assessment of tumor response. About 25% of patients show disease progression after initial cycles of chemotherapy; follow up therapy is recommended for these patients (see the NCCN guidelines for non-small cell lung cancer). Patients with effective or stable disease can continue to receive systemic therapy for 4-6 cycles. Currently, the NCCN guidelines do not recommend continuous chemotherapy over 4-6 cycles.

Recent data from the PARAMOUNT trial suggest that of platinum-based therapy is 4 cycles not optimal tumors can shrink between 4; to 6 cycles of chemotherapy. However, patients may not be able to tolerate more than 4 cycles of chemotherapy, and most of the maintenance trials used only of chemotherapy. A meta-analysis 4 cycles suggests that continuing the initial regimen beyond 4 to 6 cycles is associated with increased PFS however, patients have more; adverse events. A phase randomized trial suggested that continuing chemotherapy 3 beyond 4 to 6 cycles is not beneficial however, many patients assigned; to longer duration of therapy did not receive the planned number of cycles. In this phase 3 trial taxane-based regimens were used and. Patie The latest data from NTS had increasing neurotoxicity as more cycles were used. from the PARAMOUNT trial showed that 4 cycles of platinum based therapy is not optimal; tumor can be reduced during 4-6 cycles of chemotherapy. However, patients may not be able to tolerate more than 4 cycles of chemotherapy, so most of the maintenance trials use only 4 cycles of chemotherapy. A meta analysis showed that the initial treatment duration was longer than the 4-6 cycle and was associated with prolonged PFS; however, patients had more adverse events. A phase 3 randomized trial showed that chemotherapy that continued for more than 4-6 cycles did not benefit; however, many patients were assigned to a longer duration of treatment without a planned number of cycles. In the 3 phase of the trial, the use of taxane based chemotherapy increased neurotoxicity in patients with more cycles.

Many patients with adenocarcinoma now receive pemetrexed-based regimens and not taxane-based regimens. Pemetrexed-based regimens are less toxic than taxane-based regimens. Thus, data suggesting that more than of first-line chemotherapy are 6 cycles not appropriate may only apply to taxane-based regimens. Studies report that patients were able to 60% of receive 6 cycles of pemetrexed-based chemotherapy (and had a low incidence of toxicity whereas only, 42%) were able to receive more than of taxane-based chemotherapy and 5 cycles often stopped therapy because of is currently treated with pemetrexed based regimens neurotoxicity. many cancer patients but not with taxane based regimen. The pemetrexed based regimen was less toxic than taxane based regimen. Therefore, the data show that first-line chemotherapy over 6 cycles is inappropriate and may only be applicable to taxane based programs. The research report pointed out that 60% of the patients can be treated with pemetrexed based chemotherapy for 6 cycles (and low incidence of toxicity), and only 42% patients can receive more than 5 cycles to taxane based chemotherapy and often discontinued treatment because of toxicity.

 

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