ASCO Updates Guideline on Therapy for Advanced Lung Cancer

For immediate release
August 31, 2015


Lada Krilov

ALEXANDRIA, Va. — The American Society of Clinical Oncology (ASCO) today issued an update to its clinical practice guideline on systemic therapy for patients with stage IV non-small cell lung cancer (NSCLC). It provides evidence-based recommendations on the use of chemotherapy and targeted therapy in first-, second- and third-line treatment.

“Although there is no cure for patients with stage IV non-small cell lung cancer, various treatment options are available that can help patients control their cancer longer,” said Gregory Masters, MD, co-chair of the ASCO Expert Panel that developed the guideline. “This guideline will help doctors choose the most appropriate therapies, depending on the biology of the tumor and the patient’s general well-being.”

To develop this clinical practice guideline update, an ASCO Expert Panel conducted a formal systematic review of relevant medical literature published from January 2007 through February 2014. 

Key recommendations of the guideline update are as follows:

  • First-line (initial) treatment:
    • If tumor lacks EGFR or ALK gene alterations, combination cytotoxic chemotherapy for patients with performance status 0-1 is recommended. For patients with performance status 2, chemotherapy or palliative care alone may be used.
    • If tumor has sensitizing EGFR mutations, afatinib, erlotinib, or gefitinib is recommended.
    • If tumor has ALK or ROS1 gene rearrangements, crizotinib is recommended.
  • Maintenance treatment (treatment after initial response to first-line treatment):
    • Patients may be recommended to either switch to another regimen, or continue first-line therapy, or take a break from chemotherapy.
  • Second-line treatment:
    • Docetaxel, erlotinib, or gefinitib are options; pemetrexed is an additional option for patients with nonsquamous cell carcinoma.
    • Patients with EGFR mutations can receive chemotherapy or another EGFR inhibitor, depending on initial response.
    • Patients with ALK rearrangements may be offered chemotherapy or ceritinib.
  • Third-line treatment
    • Erlotinib may be offered for patients with performance status 0-3 who had not previously received erlotinib or gefitinib.
  • The guideline continues to emphasize that age alone should not be a factor in the selection of treatment.
  • Early palliative care, along with anti-tumor treatment is recommended.

“Early palliative care is associated with improved survival of patients with advanced lung cancer,” said David H. Johnson, co-chair of the ASCO Expert Panel. “Hospice care also improves patient quality of life and reduces caregiver distress.”

The guideline update was published today in the Journal of Clinical Oncology and is available at

Information for patients about lung cancer is available at

ASCO encourages feedback on its guidelines from oncologists, practitioners and patients through the ASCO Guidelines Wiki at


About ASCO: 

Founded in 1964, the American Society of Clinical Oncology (ASCO) is the world’s leading professional organization representing physicians who care for people with cancer. With nearly 40,000 members, ASCO is committed to improving cancer care through scientific meetings, educational programs and peer-reviewed journals. ASCO is supported by its affiliate organization, the Conquer Cancer Foundation, which funds groundbreaking research and programs that make a tangible difference in the lives of people with cancer. For ASCO information and resources, visit Patient-oriented cancer information is available at Cancer.Net.