title: The safety of second-line treatment options for non-small cell lung cancer.
abstract: Non-small-cell lung cancer (NSCLC) patients after first-line therapy ultimately suffer progression. At this time, many patients still have a good performance status and can be considered for further active treatment. Two chemotherapeutic agents, docetaxel and pemetrexed (only in non-squamous histology), and the biological drug anti-epidermal growth factor receptor (EGFR) erlotinib, were approved for clinical use in the second-line treatment of NSCLC patients. In the last few years further new second-line therapies have become available in the clinical practice. Areas covered: This review will discuss the adverse events of the pivotal trials ledding to the approval of second-line therapies for the treatment of not oncogene-addicted NSCLC patients. Expert opinion: In recent years, new second-line options for NSCLC are: the anti-EGFR, afatinib (only in squamous NSCLC); the anti-angiogenics, nintedanib (only in lung adenocarcinoma) and ramucirumab, in combination with docetaxel; the immunotherapeutics, nivolumab, pembrolizumab, and atezolizumab. In the second-line approach, the main endpoint of treatment should always be survival, but with great respect for symptoms palliation and preserving patients' quality of life. Therefore, differing toxicity profiles of the available therapeutic options are often a deciding factor in second-line setting for NSCLC.
authors.affiliation: a Division of Medical Oncology , S.G. Moscati Hospital , Avellino , Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Rossi
authors.affiliation: a Division of Medical Oncology , S.G. Moscati Hospital , Avellino , Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Maione
authors.affiliation: a Division of Medical Oncology , S.G. Moscati Hospital , Avellino , Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Santabarbara
authors.affiliation: a Division of Medical Oncology , S.G. Moscati Hospital , Avellino , Italy.
authors.forename: Paola Claudia
authors.initials: PC
authors.lastname: Sacco
authors.affiliation: a Division of Medical Oncology , S.G. Moscati Hospital , Avellino , Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Casaluce
authors.affiliation: a Division of Medical Oncology , S.G. Moscati Hospital , Avellino , Italy.
authors.forename: Assunta
authors.initials: A
authors.lastname: Sgambato
authors.affiliation: a Division of Medical Oncology , S.G. Moscati Hospital , Avellino , Italy.
authors.forename: Maria Luisa
authors.initials: ML
authors.lastname: Barzelloni
authors.affiliation: b Division of Medical Oncology , ULSS6 Euganea , Cittadella , PD , Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Palazzolo
authors.affiliation: a Division of Medical Oncology , S.G. Moscati Hospital , Avellino , Italy.
authors.forename: Cesare
authors.initials: C
authors.lastname: Gridelli
mesh_terms: D020533:Angiogenesis Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000473:pathology; D066246:ErbB Receptors / Q000037:antagonists & inhibitors; D006801:Humans; D007167:Immunotherapy / Q000379:methods; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000473:pathology; D047428:Protein Kinase Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D011788:Quality of Life; D013534:Survival
chemical_list: D020533:Angiogenesis Inhibitors; D000970:Antineoplastic Agents; D047428:Protein Kinase Inhibitors; D066246:ErbB Receptors
keywords: Afatinib; NSCLC; anti-angiogenic; atezolizumab; immunotherapy; nintedanib; nivolumab; pembrolizumab; ramucirumab; second-line