Alimta and cisplatin are FDA approved for second and first line therapy of lung cancer. Carboplatin can be substituted for cisplatin based on studies that showed equivalent therapeutic results and carboplatin is better tolerated (NCCN, 2011, p.MS-29). At this time, Alimta is FDA approved, as follows: ALIMTA is indicated in combination with cisplatin therapy for the initial treatment of patients with locally advanced or metastatic nonsquamous non-small cell lung cancer. ALIMTA is not indicated for treatment of patients with squamous cell non-small cell lung cancer. ALIMTA is indicated as a single-agent for the treatment of patients with locally advanced or metastatic nonsquamous non-small cell lung cancer after prior chemotherapy. More recently, NCCN changed the wording of its recommendations from specific chemo regimens with Avastin to “chemotherapy with Avastin”. This has been widely interpreted to include premetrexed based regimens or other regimens but NCCN did not list these regimens in its section “Systemic Therapy”. It also recommends maintenance Avastin: “Bevacizumab + chemotherapy or chemotherapy alone is indicated in PS 0-1 patients with advanced or recurrent NSCLC. Bevacizumabshould be given until disease progression.”
Uptodate, on the other hand, considers combination of carboplatin/Alimta/Avastin standard of care for first-line chemotherapy regimen in metastatic NSCLC. NCCN also
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