Second-line treatment for advanced non-small cell lung cancer:: A systematic review

Background: Among advanced non-smail. cell lung cancer (NSCLC) patients, most will resist or relapse after first-line chemotherapy. As a result, second-tine therapy has been a major focus for clinical research. Materials and methods: A systematic review was carried out from 1996 to February 2005. Results: Second-line chemotherapy provides pre-treated NSCLC patients with a clear survival advantage. Docetaxel 75 mg/ml every 3 weeks is the present standard second-line chemotherapy. Despite promising results regarding efficacy and toxicity in phase III studies, a docetaxet weekly schedule could not be recommended. Pemetrexed recently emerged as an alternative with similar efficacy and less toxicity. Although the combination of two drugs was not associated with a survival benefit when compared with single-agent chemotherapy, such regimens induced a dramatic increase in toxicities and therefore mono - chemotherapy remains the standard as second-tine therapy. Finally, few new agents were reported with better results than those used previously and clinical research on second-line therapy currently focuses on combinations with targeted therapies. Conclusion: Second-line chemotherapy offers NSCLC patients a small but significant survival improvement. However, this field of clinical research needs further investigations in order to answer certain remaining questions especially concerning targeted therapies. (c) 2005 Elsevier Ireland Ltd. All rights reserved.