This is the current release of the guideline.

This guideline updates a previous version Socinski MA, Morris DE, Masters GA, Lilenbaum R. Chemotherapeutic management of stage IV non-small cell lung cancer. Chest 2003 Jan;123(1 Suppl):226S-43S.

Definitions for the strength of evidence and recommendation grades (1A-2C) follow the recommendations.

1. In patients with stage IV non-small cell lung carcinoma (NSCLC) and a good performance status (PS), two-drug combination chemotherapy is recommended. The addition of a third cytotoxic chemotherapeutic agent is not recommended because it provides no survival benefit and may be harmful. Grade of recommendation, 1A
2. Bevacizumab improves survival combined with carboplatin and paclitaxel in a clinically selected subset of patients with stage IV NSCLC and good PS (nonsquamous histology, lack of brain metastases, and no hemoptysis). In these patients, addition of bevacizumab to carboplatin and paclitaxel should be considered a therapeutic option. Grade of recommendation, 1A
3. In patients who have stage IV NSCLC and are elderly (> 70 years old), single-agent chemotherapy is recommended for most. Grade of recommendation, 1A
4. However, in patients who have stage IV NSCLC, are elderly (≥70 years old), have a good PS, and lack significant comorbidities, two-drug combination chemotherapy is recommended as an option. Grade of recommendation, 1B
5. In patients who have stage IV NSCLC and are ≥80 years old, the benefit of chemotherapy is unclear and should be decided on the basis of individual circumstances. Grade of recommendation, 2C
6. In patients with stage IV NSCLC and a PS of 2, chemotherapy is recommended on the basis of defined response rates and symptom palliation. Grade of recommendation, 1B
7. In patients with stage IV NSCLC and a PS of 2, no specific recommendation can be given with regard to the optimal chemotherapeutic strategy. A single phase III trial showed a survival benefit to a carboplatin-based doublet compared with a single agent in a prospectively planned subset analysis. Grade of recommendation, 2C
8. It is recommended that patient-reported health-related quality of life be measured using the Functional Assessment of Cancer Therapy-Lung (FACT-L) or European Organization for Research and Cancer Treatment Quality of Life Questionnaire (EORTC QLQ-C30) questionnaire because it is a significant prognostic factor for survival. Grade of recommendation, 1A
9. It is recommended that patients with stage IV NSCLC receive adequate education about the risks and benefits of chemotherapy to enable active participation in the decision-making process regarding treatment selection. Grade of recommendation, 1C

Definitions:

Quality of Evidence Scale

High - Randomized controlled trials (RCTs) without important limitations or overwhelming evidence from observational studies*

Moderate - RCTs with important limitations (inconsistent results, methodologic flaws, indirect, or imprecise) or exceptionally strong evidence from observational studies*

Low or very low - Observational studies or case series

*Although the determination of magnitude of the effect based on observational studies is often a matter of judgment, the guideline developers offer the following suggested rule to assist this decision: a large effect would be a relative risk > 2 (risk ratio < 0.5) [which would justify moving from weak to moderate], and a very large effect is a relative risk > 5 (risk ratio < 0.2) [which would justify moving from weak to strong]. There is some theoretical justification in the statistical literature for these thresholds (the magnitude of effect that is unlikely or very unlikely to be due to residual confounding after adjusted analysis). However, once the decision is made, authors should be explicit in justifying their decisions.

Grade of Recommendations Scale

Relationship of Strength of the Supporting Evidence to the Balance of Benefits to Risks and Burdens

None provided

The type of supporting evidence is identified and graded for each recommendation (see "Major Recommendations").

Not applicable: The guideline was not adapted from another source.

2003 Jan (revised 2007 Sep)

American College of Chest Physicians - Medical Specialty Society

American College of Chest Physicians

American College of Chest Physicians (ACCP) Expert Panel on Lung Cancer Guidelines

Primary Authors: Mark A. Socinski, MD, FCCP; Richard Crowell, MD, FCCP; Thomas E. Hensing, MD; Corey J. Langer, MD; Rogerio Lilenbaum, MD; Alan B. Sandler, MD; David Morris, MD

American Association for Bronchology - Disease Specific Society
American Association for Thoracic Surgery - Medical Specialty Society
American College of Surgeons - Medical Specialty Society
American Society for Therapeutic Radiology and Oncology
Asian Pacific Society of Respirology - Disease Specific Society
Oncology Nursing Society - Professional Association
Society of Thoracic Surgeons - Medical Specialty Society
World Association of Bronchology - Disease Specific Society

This is the current release of the guideline.

This guideline updates a previous version Socinski MA, Morris DE, Masters GA, Lilenbaum R. Chemotherapeutic management of stage IV non-small cell lung cancer. Chest 2003 Jan;123(1 Suppl):226S-43S.

This NGC summary was completed by ECRI on September 3, 2003. The information was verified by the guideline developer on October 1, 2003. This NGC summary was updated by ECRI Institute on November 27, 2007. The updated information was verified by the guideline developer on December 21, 2007.

This NGC summary is based on the original guideline, which is subject to the guideline developer's copyright restrictions.