title: Factors driving the choice of the best second-line treatment of advanced NSCLC.
abstract: Platinum-based chemotherapy, with or without the antiangiogenetic drug bevacizumab, is the standard first-line therapy for patients with advanced non-small-cell lung cancer (NSCLC). The epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) gefitinib has been recently approved as treatment of patients with EGFR mutated tumors (including first-line). Three agents are approved for treating non-selected patients who progress after one prior regimen: docetaxel, pemetrexed, and the EGFR-TKI erlotinib. Gefitinib can be used as second-line treatment in patients with EGFR mutated tumors. Although these agents have yelded similar outcomes in terms of antitumor activity and efficacy in unselected NSCLC patients, they have different toxicity profiles, and recently some strong factors that can help in the choice among them have been detected. In particular, the hystotype, the EGFR gene mutational status, the response to previous first-line chemotherapy and the correlation of the safety profile of the agents with Performance Status and comorbidities of the patients, are the most important factors that drive the choice of the second-line treatment. Obviously, the drugs administered in the first-line treatment strongly influence the choice of the second-line treatment because some of the currently available drugs can be used in both settings. Thus, more than in the past, first and second-line treatment of advanced NSCLC are linked, and the choice of second-line treatment is part of a strategy decided when beginning the first-line treatment.
authors.affiliation: Division of Medical Oncology, "S.G. Moscati" Hospital, Contrada Amoretta - 83100 Avellino, Italy. pmaione@libero.it
authors.forename: Paolo
authors.initials: P
authors.lastname: Maione
authors.forename: Antonio
authors.initials: A
authors.lastname: Rossi
authors.forename: Maria Anna
authors.initials: MA
authors.lastname: Bareschino
authors.forename: Paola Claudia
authors.initials: PC
authors.lastname: Sacco
authors.forename: Clorinda
authors.initials: C
authors.lastname: Schettino
authors.forename: Marzia
authors.initials: M
authors.lastname: Falanga
authors.forename: Valentina
authors.initials: V
authors.lastname: Barbato
authors.forename: Rita
authors.initials: R
authors.lastname: Ambrosio
authors.forename: Cesare
authors.initials: C
authors.lastname: Gridelli
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy*; D003657:Decision Making; D000077143:Docetaxel; D066246:ErbB Receptors / Q000037:antagonists & inhibitors; D000077156:Gefitinib; D005971:Glutamates / Q000627:therapeutic use*; D006147:Guanine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy*; D000068437:Pemetrexed; D011799:Quinazolines / Q000627:therapeutic use*; D043823:Taxoids / Q000627:therapeutic use*; D013940:Thymidylate Synthase / Q000037:antagonists & inhibitors
chemical_list: D000970:Antineoplastic Agents; D005971:Glutamates; D011799:Quinazolines; D043823:Taxoids; D000068437:Pemetrexed; D000077143:Docetaxel; D006147:Guanine; D013940:Thymidylate Synthase; D066246:ErbB Receptors; D000077156:Gefitinib