First-, Second-, and Third-Line Treatment for NSCLC

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The management of NSCLC is generally a lengthy process that requires several chemotherapy regimens. Jyoti D. Patel, MD, notes that clinicians should consider first-line, second-line, and third-line options, while also factoring in breaks from treatment so that patients may recover from toxicity. Patel assesses all available options early on, including enrollment in clinical trials, and then develops a course of treatment.

Carboplatin and paclitaxel may be used as first-line chemotherapy; patients who receive this regimen will generally experience some neuropathy. Second-line options in patients with wild-type disease include docetaxel, pemetrexed, and erlotinib. Patel notes that if docetaxel or paclitaxel was given as first-line therapy, then he usually offers pemetrexed as second-line treatment, and if pemetrexed was given first, then he considers a taxane as second-line treatment. Docetaxel is not usually given after paclitaxel due to cumulative toxicity.