title: Management of Italian patients with advanced non-small-cell lung cancer after second-line treatment: results of the longitudinal phase of the LIFE observational study.
abstract: BACKGROUND
  Patients with advanced NSCLC who experience disease progression after second-line therapy might receive further active treatment. LIFE was an Italian cohort multicenter observational study composed of a cross-sectional and a longitudinal phase.
  
  
  METHODS
  In the longitudinal phase, described here, the primary aim was to determine the proportion of patients receiving third-line therapy among those who received second-line active treatment according to clinical practice. The proportion of patients receiving further treatment lines was also estimated.
  
  
  RESULTS
  The longitudinal phase was conducted between January and August 2012. Of 464 patients who began second-line therapy outside of clinical trials within the baseline evaluation, 56 (12.1%) were still receiving second-line therapy at the end of the observation period and 17 (3.7%) withdrew during or after second-line therapy. Of the remaining 391 patients, 158 (40.4%) received third-line treatment outside of clinical trials: 93 received a third-line chemotherapy and 65 a targeted agent. The main reason for interrupting third-line treatment was disease progression or death. During the same observation period, 25 of 113 patients who completed a third-line therapy received a fourth line of treatment. From diagnosis of NSCLC to the end of observation, biomarkers were tested in 323 patients (59.7%): epidermal growth factor receptor mutations in 315 (58.2%), Kirsten rat sarcoma 2 viral oncogene homolog (KRAS) mutations in 83 (15.3%) and Anaplastic lymphoma kinase (ALK) translocation in 84 (15.5%).
  
  
  CONCLUSIONS
  In Italian clinical practice, the proportion of patients with advanced NSCLC receiving more than 2 treatment lines of therapy is not negligible.
authors.affiliation: UOC Pneumologia Oncologica, A.O. San Camillo Forlanini, Rome, Italy; Thoracic Oncology Division, European Institute of Oncology (IEO), Milan, Italy. Electronic address: filippo.demarinis@ieo.it.
authors.forename: Filippo
authors.initials: F
authors.lastname: de Marinis
authors.affiliation: U.O. Oncologia Medica, Azienda Ospedaliera di Parma, Parma, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Ardizzoni
authors.affiliation: U.O. Oncologia II Univ., Azienda Ospedaliero Universitaria Pisana, Pisa, Italy.
authors.forename: Gabriella
authors.initials: G
authors.lastname: Fontanini
authors.affiliation: S.S. Tumori Polmonari, IRCCS A.O.U. San Martino-IST Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Grossi
authors.affiliation: Oncologia, Ospedale di Livorno - Oncologia, Livorno, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Cappuzzo
authors.affiliation: Oncologia, Università di Torino; A.O.U. San Luigi Gonzaga, Orbassano, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Novello
authors.affiliation: GIVOP (Gruppo Interdisciplinare Veronese Oncologia Polmonare), Ospedale Civile Maggiore Borgo Trento - Oncologia Medica D.O., Verona, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Santo
authors.affiliation: Oncologia Medica Pad. oncologico Ospedale V. Fazzi, Lecce, Italy.
authors.forename: Vito
authors.initials: V
authors.lastname: Lorusso
authors.affiliation: UO Oncologia Medica Ospedale San Gerardo, Monza, Italy.
authors.forename: Diego
authors.initials: D
authors.lastname: Cortinovis
authors.affiliation: Boehringer Ingelheim S.p.A., Milano, Italy.
authors.forename: Monica
authors.initials: M
authors.lastname: Iurlaro
authors.affiliation: Oncologia Medica IRCCS Giovanni Paolo II Ospedale Oncologico, Bari, Italy.
authors.forename: Domenico
authors.initials: D
authors.lastname: Galetta
authors.affiliation: Oncologia Medica, A.O.R.N. San Giuseppe Moscati, Avellino, Italy.
authors.forename: Cesare
authors.initials: C
authors.lastname: Gridelli
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000077548:Anaplastic Lymphoma Kinase; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D014408:Biomarkers, Tumor / Q000378:metabolism; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000235:genetics / Q000473:pathology; D015331:Cohort Studies; D018450:Disease Progression; D066246:ErbB Receptors / Q000235:genetics; D000069347:Erlotinib Hydrochloride; D005260:Female; D006801:Humans; D007558:Italy; D008137:Longitudinal Studies; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000235:genetics / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009154:Mutation; D011518:Proto-Oncogene Proteins / Q000235:genetics; D016283:Proto-Oncogene Proteins p21(ras); D011799:Quinazolines / Q000627:therapeutic use; D020794:Receptor Protein-Tyrosine Kinases / Q000235:genetics; D018631:ras Proteins / Q000235:genetics
chemical_list: D000970:Antineoplastic Agents; D014408:Biomarkers, Tumor; C117307:KRAS protein, human; D011518:Proto-Oncogene Proteins; D011799:Quinazolines; D000069347:Erlotinib Hydrochloride; C000626173:ALK protein, human; C000626175:Alk protein, rat; D000077548:Anaplastic Lymphoma Kinase; D066246:ErbB Receptors; D020794:Receptor Protein-Tyrosine Kinases; D016283:Proto-Oncogene Proteins p21(ras); D018631:ras Proteins
keywords: Chemotherapy; EGFR; Erlotinib; NSCLC; Third-line