title: Beyond "second-line" in non-small cell lung cancer: therapy and supportive care.
abstract: Although there once was a single algorithm for the treatment of patients with advanced lung cancer, the modern treatment of advanced lung cancer has multiple treatment pathways that depend on multiple factors, including histology and molecular subtype of disease. New molecular targets, targeted agents, and modes of therapy for patients, including immunotherapy, are being identified at an accelerating pace. These advances are changing outcomes and the treatment landscape, but they also highlight situations with inadequate data to support the use of cytotoxic chemotherapy. In this article, we provide an overview of data regarding cytotoxic chemotherapy and targeted therapy and their value after second line, review the critical role of supportive care and palliative care, and emphasize the importance of advance care planning with our patients. Although this article focuses primarily on NSCLC, the comments about palliative care and advanced care planning also apply to patients with small cell lung cancer.
authors.affiliation: From Seattle Cancer Care Alliance, University of Washington, Seattle, WA; US Oncology Research, Ocala, FL; Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, NY.
authors.forename: Renato G
authors.initials: RG
authors.lastname: Martins
authors.affiliation: From Seattle Cancer Care Alliance, University of Washington, Seattle, WA; US Oncology Research, Ocala, FL; Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, NY.
authors.forename: Craig H
authors.initials: CH
authors.lastname: Reynolds
authors.affiliation: From Seattle Cancer Care Alliance, University of Washington, Seattle, WA; US Oncology Research, Ocala, FL; Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, NY.
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Riely
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000473:pathology / Q000628:therapy*; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000628:therapy*; D010166:Palliative Care