[First-line chemotherapy for metastatic non-small cell carcinoma: what are the options].
Until recently, first-line chemotherapy for advanced non-small cell lung cancer (NSCLC) was based on ASCO guidelines. Since several years, first-line chemotherapy is a platin-based doublet for patients with a good performans status. For elderly or unfit patients, a single-drug chemotherapy or a combination without cisplatin was recommended. The association of an anti-angiogenic therapy, bevacizumab, with carboplatin-paclitaxel or cisplatin-gemcitabine regimens improves progression-free survival for patients with non-epidermoid tumors. The combination of cisplatin and pemetrexed is better in terms of survival than cisplatine-gemcitabine in these tumors. The choice of treatment according to histology is becoming a new concept. Another is maintenance therapy. The main objective is to reduce duration of platin-based chemotherapy while improving quality of life and progression-free survival. This concept is ongoing validation. The combination of cetuximab with platin-chemotherapy improves survival for all histologic types. We should integrate this new approach among other available treatments. First-line therapy for advanced NSCLC is changing. In the future, first-line therapy will be chosen according to clinical features and biomarkers such as gene mutations of EGFR.
Fournel
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Institut de Cancérologie de la Loire (ICL), 108 bis avenue Albert Raimond, 42271 Saint-Priest-en-Jarez cedex. pierre.fournel@icloire.fr
D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000556:secondary*; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000473:pathology*
D000970:Antineoplastic Agents