title: Second-line treatment for advanced non-small cell lung cancer: a systematic review.
abstract: BACKGROUND
  Among advanced non-small cell lung cancer (NSCLC) patients, most will resist or relapse after first-line chemotherapy. As a result, second-line therapy has been a major focus for clinical research.
  
  
  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/m(2) every 3 weeks is the present standard second-line chemotherapy. Despite promising results regarding efficacy and toxicity in phase III studies, a docetaxel 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-line 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Faculty of Medicine, Université de la Méditerranée, Assistance Publique Hôpitaux de Marseille, Thoracic Oncology, Fédération des Maladies Respiratoires, Sainte-Marguerite Hospital, France. fabrice.barlesi@mail.ap-hm.fr
authors.forename: Fabrice
authors.initials: F
authors.lastname: Barlési
authors.forename: William
authors.initials: W
authors.lastname: Jacot
authors.forename: Philippe
authors.initials: P
authors.lastname: Astoul
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Pujol
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000401:mortality; D002986:Clinical Trials as Topic; D004334:Drug Administration Schedule; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000401:mortality
chemical_list: D000970:Antineoplastic Agents