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Second-Line Treatment in NSCLC

Insight From: Primo N. Lara, Jr, MD, UC Davis; Benjamin P. Levy, MD Mount Sinai; Jyoti D. Patel, MD Northwestern 
Published: Tuesday, Apr 21, 2015
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Despite the improvements that have been made with targeted therapy and chemotherapy, patients with non-small cell lung cancer (NSCLC) will eventually experience disease progression, requiring second-line therapy, remarks Jyoti D. Patel, MD. In general, second-line treatment improves overall survival and provides symptom control; however, Patel notes that in patients who were refractory to front-line therapy, there is also less likelihood of a significant disease response to second-line therapy.

At this point, erlotinib, pemetrexed, and docetaxel are the only medications approved as second-line options for patients with advanced NSCLC. Additionally, in March 2015, the FDA approved the anti–PD-1 agent nivolumab as a treatment for patients with advanced squamous NSCLC following progression on or after platinum-based chemotherapy.

When determining the most appropriate second-line therapy, it is important to consider toxicity, tolerability, and patient preference, Benjamin P. Levy, MD, notes. For instance, patients who struggled with first-line chemotherapy may not be able to tolerate docetaxel, and an alternative agent or enrollment into a clinical trial may need to be considered.

Primo N. Lara, MD, comments that many patients seen in clinical practice do not quite match the patients who were enrolled in clinical trials. In Lara's practice, patients have a poorer performance status, often with comorbidities that may preclude them from receiving the regimens evaluated in clinical trials. However, Lara notes that these patients may still be candidates for second-line chemotherapy. As toxicities may be more pronounced in patients with poor performance status, he remarks that these patients should be monitored more carefully.
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For High-Definition, Click
Despite the improvements that have been made with targeted therapy and chemotherapy, patients with non-small cell lung cancer (NSCLC) will eventually experience disease progression, requiring second-line therapy, remarks Jyoti D. Patel, MD. In general, second-line treatment improves overall survival and provides symptom control; however, Patel notes that in patients who were refractory to front-line therapy, there is also less likelihood of a significant disease response to second-line therapy.

At this point, erlotinib, pemetrexed, and docetaxel are the only medications approved as second-line options for patients with advanced NSCLC. Additionally, in March 2015, the FDA approved the anti–PD-1 agent nivolumab as a treatment for patients with advanced squamous NSCLC following progression on or after platinum-based chemotherapy.

When determining the most appropriate second-line therapy, it is important to consider toxicity, tolerability, and patient preference, Benjamin P. Levy, MD, notes. For instance, patients who struggled with first-line chemotherapy may not be able to tolerate docetaxel, and an alternative agent or enrollment into a clinical trial may need to be considered.

Primo N. Lara, MD, comments that many patients seen in clinical practice do not quite match the patients who were enrolled in clinical trials. In Lara's practice, patients have a poorer performance status, often with comorbidities that may preclude them from receiving the regimens evaluated in clinical trials. However, Lara notes that these patients may still be candidates for second-line chemotherapy. As toxicities may be more pronounced in patients with poor performance status, he remarks that these patients should be monitored more carefully.
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