Treating with new chemo drugs after first attempt at chemo fails in non-small cell lung cancer is supported by credible evidence. I will discuss second line chemoing.
Two randomized clinical trials have been reported that addressed the issue of second-line treatment in patients with advanced NSCLC that progresses after they have received first-line platinum-based chemotherapy. Both trials used docetaxel because this agent had shown significant activity in this patient population in single-arm phase II trials. Several of the other new agents have been studied in the second-line setting, including paclitaxel, gemcitabine, irinotecan, and vinorelbine(Navelbine). In general, these trials have included small numbers of patients with variable results. Response rates have ranged from 0 to 20% and median survival rates (when reported) of 4 to 8 months. No randomized trials including these other agents exist with the exception of gemcitabine/vinorelbine.
A recent review recommended that patients with a good PS who are experiencing disease progression after receiving platinum-based chemotherapy should be offered second-line chemotherapy. Level of evidence, good; benefit, moderate; grade of recommendation, B.
ASCO in 2009 recommended: “Docetaxel, erlotinib, gefitinib, or pemetrexed is acceptable as second-line therapy for patients with advanced NSCLC with adequate PS when the disease has progressed during or after first-line, platinum-based therapy. ”
NCCN on p. NSCL 16 recommends docetaxel, premetrexed, erlotinib, platinum doublet with Avastin if erlotinib or crizotinib were given first line.
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