title: Second-Line Treatment Selection in Patients With Non-Small-Cell Lung Cancer of Adenocarcinoma Histology: Findings From a European Survey of Treating Physicians.
abstract: Guidelines provide treatment recommendations for advanced non-small-cell lung cancer (NSCLC), but physicians must also consider other factors. We surveyed physicians treating NSCLC to determine their therapy goals, drivers of treatment choice, current prescribing behavior, and therapy expectations.
  
  
  
  In 2015, an online survey was conducted of 500 pulmonologists/oncologists treating lung adenocarcinoma in Germany, France, Italy, Spain, and the United Kingdom, comprising screening and therapy decision questions.
  
  
  
  On average, physicians had 14.7 years of experience and treated 79 patients/3 months with stage IIIb/IV NSCLC. In patients with Eastern Cooperative Oncology Group (ECOG) 0-1, "prolonged survival/extending life" was the main therapy goal of physicians for first- (63%) and second-line (40%) patients; improvement in quality of life (QoL) was the main goal of 14% of physicians for second-line patients. For patients with ECOG ≥2, the main goal of second-line therapy was improvement in QoL (26%) or tumor-related symptoms (23%). Most (57%) physicians strongly agreed that they preferred a second-line treatment that extends overall survival (OS) while maintaining QoL; their greatest dissatisfaction with available second-line treatment options was the inability to "stop tumor progression over the long term" (66%). Physicians expected new therapies to become available within 12 months that would provide improvements in progression-free survival (83%) or OS (69%).
  
  
  
  OS is important for second-line treatments in patients with stage IIIb/IV NSCLC, although QoL improvements should not be underestimated. This survey highlights the wait faced by patients and physicians as treatments transition from clinical trials to clinical practice.
authors.affiliation: Department of Respiratory Medicine, Institute of Oncology of the Hospices Civils de Lyon, Lyon, France. Electronic address: nicolas.girard@chu-lyon.fr.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Girard
authors.affiliation: Department of Medical Oncology, Virgen del Rocio University Hospital, Seville, Spain.
authors.forename: Jesus
authors.initials: J
authors.lastname: Corral
authors.affiliation: Medical Oncology Unit, San Gerardo Hospital, Monza, Italy.
authors.forename: Diego
authors.initials: D
authors.lastname: Cortinovis
authors.affiliation: Thoracic Oncology, Lungen Clinic Grosshansdorf, Member of the German Center for Lung Research, Grosshansdorf, Germany.
authors.forename: David F
authors.initials: DF
authors.lastname: Heigener
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000628:therapy*; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology / Q000628:therapy*; D005060:Europe; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology / Q000628:therapy*; D018579:Patient Selection; D010818:Practice Patterns, Physicians' / Q000592:standards*; D011788:Quality of Life; D016879:Salvage Therapy / Q000639:trends*; D011795:Surveys and Questionnaires
keywords: Chemotherapy; Metastatic; Overall survival; Progression-free survival; Quality of life