• Noble J, Ellis P, Mackay JA, Evans WK, Lung Cancer Disease Site Group. Second-line or subsequent systemic therapy for recurrent or progressive non-small cell lung cancer: a clinical practice guideline. Toronto (ON): Cancer Care Ontario (CCO); 2006 Mar 27. 51 p. (Evidence-based series; no. 7-19). [89 references]

• Single-agent docetaxel (Taxotere®) at a dose of 75 mg/m² every three weeks is recommended as second-line therapy for patients with recurrent or progressive non-small cell lung cancer (NSCLC) and adequate performance status (0-2).
• Single-agent pemetrexed (Alimta®) at a dose of 500 mg/m² every three weeks is also an option for second-line therapy of recurrent or progressive disease, if available. This chemotherapy should be administered with vitamin supplements: oral folic acid 350-1,000 micrograms daily and intramuscular vitamin B₁₂ 1,000 micrograms every nine weeks, beginning between one to two weeks before, and continuing until three weeks after chemotherapy.
• Oral topotecan at a dose of 2.3 mg/m² administered day 1-5 every three weeks is not recommended for second-line therapy of recurrent or progressive disease.
• Docetaxel administered at a dose of 33.3-40 mg/m² (for six weeks on an eight-week cycle or for three weeks on a four-week cycle) may be considered in patients at high risk of hematologic toxicity or with a previous history of febrile neutropenia using the three-weekly docetaxel schedule.
• Combination chemotherapy (docetaxel-based or other) is not currently recommended as second-line or subsequent therapy for recurrent or progressive disease.
• Erlotinib at a dose of 150 mg/day is recommended as third-line therapy for patients with advanced recurrent or progressive non-small cell lung cancer who maintain a good performance status following previous platinum-based and docetaxel (or pemetrexed) chemotherapy. Erlotinib is also an option for second-line therapy, particularly in patients who are not candidates for chemotherapy or for those with progression after first-line docetaxel-platinum chemotherapy.
• Gefitinib at a dose of 250 mg/day may be considered for second-line and subsequent therapy only for selected symptomatic patients who are not candidates for chemotherapy and for whom erlotinib is not available.

None provided

The recommendations are supported by randomized phase II and III trials.

• Noble J, Ellis P, Mackay JA, Evans WK, Lung Cancer Disease Site Group. Second-line or subsequent systemic therapy for recurrent or progressive non-small cell lung cancer: a clinical practice guideline. Toronto (ON): Cancer Care Ontario (CCO); 2006 Mar 27. 51 p. (Evidence-based series; no. 7-19). [89 references]

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

2001 Jan 17 (revised 2006 Mar 27)

Program in Evidence-based Care - State/Local Government Agency [Non-U.S.]

The Program in Evidence-based Care (PEBC) is a Province of Ontario initiative sponsored by Cancer Care Ontario and the Ontario Ministry of Health and Long-Term Care.

Cancer Care Ontario
Ontario Ministry of Health and Long-Term Care

Provincial Lung Cancer Disease Site Group

All members of the Lung Cancer Disease Site Group disclosed potential conflict of interest information. None of the authors of this systematic review declared any conflicts of interest.

None available

This summary was completed by ECRI on July 19, 2002. The information was verified by the guideline developer on August 19, 2002. This summary was updated by ECRI on September 9, 2005. The updated information was verified by the guideline developer on October 3, 2005. This summary was updated by ECRI on June 8, 2006. The updated information was verified by the guideline developer on June 26, 2006. This summary was updated by ECRI Institute on October 16, 2008 following the U.S. Food and Drug Administration (FDA) advisory on Tarceva (erlotinib).