WEDNESDAY, Nov. 18 (HealthDay News) -- The American Society of Clinical Oncology (ASCO) updated guidelines for chemotherapy and biologic therapy for stage IV non-small cell lung cancer were published online Nov. 16 in the Journal of Clinical Oncology.

Christopher G. Azzoli, M.D., of Memorial Sloan-Kettering Cancer Center in New York City, and colleagues on the ASCO Update Committee reviewed 162 articles published in 2002 to 2009. The reviewers looked primarily at strategies that improved overall survival, but also scrutinized studies showing progression-free survival.

The update recommends that patient age not determine the cancer treatment, recommending that the patient's physiological age and performance status be considered instead. The guidelines also make specific first-, second-, and third-line recommendations. The first line recommendations include: 1) cisplatin or carboplatin chemotherapy combined with a second drug, such as docetaxel, gemcitabine, irinotecan, paclitaxel, pemetrexed or vinorelbine; 2) bevacizumab with carboplatin plus paclitaxel in particular circumstances; 3) adding cetuximab to cisplatin plus vinorelbine if a the tumor tests positive for EGFR protein; and 4) gefitinib in patients with a tumor that tests positive for an activating EGFR gene mutation. For second line treatment, the recommendation is use of a single drug, such as docetaxel, erlotinib, gefitinib or pemetrexed, while third-line treatment is erlotinib for patients (when erlotinib or gefitinib has not been used previously).

"Ethnic and racial minorities experience worse outcomes compared to whites in all stages of lung cancer, and these disparities are frequently due to communication barriers between doctors and their patients," Azzoli said in a statement.

Several study authors reported receiving honoraria or research grants from, or acting as advisors for, pharmaceutical companies.

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