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Lung Cancer
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my personal edition > lung cancer > news
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DGDispatch
Targeted Agents Added to Guidelines for Non-Small Cell Lung Cancer: Presented at NCCN
By Ed Susman
HOLLYWOOD, F.L. -- March 20, 2006 -- Two targeted agents have been added to the guidelines for treatment of advanced non-small cell lung cancer by the National Comprehensive Cancer Network (NCCN).
"We made a number of changes in the guidelines for lung cancer," David Ettinger, MD, professor of oncology and medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States. "But the most important change involved adding bevacizumab (Avastin) and erlotinib (Tarceva)."
Although use of these newer drugs does not offer lung cancer patients a cure, they do prolong survival, Dr. Ettinger said. "A few years ago, the idea that we could have a 2-year survival for patients with Stage IV non-small cell lung cancer was not in the picture. But now we are seeing that 22% of these patients are surviving 2 years and longer."
Overall, said Mark Kris, MD, chief of the thoracic oncology service, Memorial Sloan-Kettering Cancer Center, New York, New York, United States, the use of the targeted therapies extend overall survival around 4 months over treatments that do not include the small molecule drugs, he said March 9, 2006, at the 11th annual conference of the NCCN.
While 4 months may not seem clinically significant, Dr. Ettinger said that the difference continues to push survival further along in the right direction. "I can see the time that we will be able to treat advanced lung cancer much the way we treat people with diabetes -- as a chronic disease," he said.
The NCCN is a consortium of 19 major cancer hospitals, including both Johns Hopkins and Memorial Sloan-Kettering. Since 1996, the NCCN developed treatment algorithms for virtually all known forms of cancer. The guidelines are now used as a standard-of-care in government demonstration projects and have gained national and international acceptance.
In updating the lung cancer guidelines, Dr. Ettinger slated Avastin as a first-line treatment for patients with an acceptable performance status, that is, patients who were otherwise in good physical condition. Avastin should be used with standard chemotherapy for lung cancer, according to the guidelines, while Tarceva one of three choices for second-line or third-line treatment.
Dr. Kris noted that while Avastin therapy appears to extend survival, it is not without side effects, some of which can prove fatal in some patients. He also said that while the guidelines are not specific on long-term use of Tarceva, most doctors continue to deliver the drug as long as patients do not appear to have disease progression.
The length of time that patients should be treated will likely be addressed in the 2007 update in the guidelines, Dr. Ettinger said.
[Presentation title: Update: Non-Small Cell Lung Cancer Guidelines.]
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