Second-line chemotherapy for non-small cell lung cancer.
BACKGROUND
The role of second-line chemotherapy for the treatment of patients with non-small cell lung cancer (NSCLC) who have relapsed or failed to respond to first-line treatment was unclear.


OBJECTIVE
To determine the effectiveness of any second-line chemotherapy in patients with NSCLC.


METHODS
Bibliographic databases were searched. Handsearching and contact with experts was also performed.


METHODS
Randomised controlled clinical trials in which any second-line chemotherapy was compared with BSC in patients with NSCLC who had previously failed to any previous chemotherapy regimen.


METHODS
Data was extracted by 2 independent reviewers and revised by all authors.


RESULTS
Only one study was included. It randomised 204 patients to receive either doxetaxel or BSC. Following an unacceptably high toxic death rate the dose of doxetaxel was reduced from 100 mg/m(2) to 75 mg/m(2). Doxetaxel gave an extra 2.4 months of survival - an average of 7.0 months vs 4.6 months on BSC. At 1 year after diagnosis 29% of doxetaxel treated patients were alive compared with 19% of the BSC group.


CONCLUSIONS
Definitive recommendations cannot be made since evidence is only available from one randomised controlled trial which, though of reasonable quality, had a number of limitations. There is currently no evidence to support second-line treatment of patients with poor performance status. Larger, well-designed controlled trials are needed to further evaluate whether the benefits of second-line chemotherapy to patients with NSCLC outweigh its risks and costs.
Bonfill
X
X
Centro Cochrane Iberoamericano., Hospital de la Santa Creu i Sant Pau, Sant Antoni M. Claret 171, Barcelona, Catalonia, Spain, 08041. XBonfill@hsp.santpau.es
Serra
C
C
Sacristán
M
M
Nogué
M
M
Losa
F
F
Montesinos
J
J
D000972:Antineoplastic Agents, Phytogenic / Q000009:adverse effects / Q000627:therapeutic use*; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy*; D000077143:Docetaxel; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy*; D017239:Paclitaxel / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D043823:Taxoids
D000972:Antineoplastic Agents, Phytogenic; D043823:Taxoids; D000077143:Docetaxel; D017239:Paclitaxel