Chemotherapeutic management of stage IV XXXX .

@entity1 @entity1149 @entity3 @entity2
Stage IV @entity1149 ( @entity1149 ) denotes the presence of @entity3 and is largely incurable using present-day therapies. Chemotherapy remains a therapeutic option in this @entity1 population, and there are many pertinent issues surrounding its use in @entity1 with stage IV @entity1149 . Eleven questions were framed by the American College of Chest Physicians @entity2 Guidelines Committee, and these were addressed by a systematic search of the available literature. The issues addressed included the identification of prognostic factors in selecting @entity1 for chemotherapy and a critical analysis of the survival benefit provided by chemotherapy. Given the development of several new chemotherapy agents over the past decade, the impact that these agents have made was addressed as well as the definition of a standard of care regarding chemotherapeutic regimens. Given the fact that chemotherapy does not represent a curative option, other issues addressed were the optimal duration of treatment as well as its impact on symptom relief and quality of life, the role of second-line therapy, and the outcomes expectations from both first-line and second-line chemotherapy. The question of what specialty delivered the chemotherapy also was addressed. Once the data were identified, a critical analysis was undertaken attempting to objectively portray the data in support of answers for each of the questions posed. We believe the data support the fact that properly selected @entity1 benefit from chemotherapy with regard to survival and palliation in both first-line and second-line settings. It appears that in trials addressing the duration of first-line therapy, this survival and palliative benefit occurs early, and prolonged therapy is not indicated. Therapy in this setting is cost-effective, and there are several regimens that can be considered to be "standard-of-care" options. Physicians involved in the diagnosis of these @entity1 should be aware of the potential benefits of chemotherapy, allowing them to give recommendations to @entity1 that are based on data derived from clinical trials. In addition, this awareness will allow them to make referrals, when appropriate, to physicians who are trained in the administration of chemotherapy and the management of @entity1 undergoing such therapy.
