Second or third-line chemotherapy in NSCLC

Several single agents have been evaluated in non-randomised trials for activity as second-line or beyond in advanced NSCLC with docetaxel, paclitaxel, gemcitabine, and pemetrexed being the most efficient. Based on phase II data, active combination chemotherapy regimens comprises gemcitabine in combination with agents such as docetaxel, paclitaxel, or vinorelbine, and cisplatin together with irinotecan or paclitaxel. Docetaxel has been the most intensively evaluated drug in randomised trials with documented increase in survival and quality of life (QoL). Pemetrexed has similar activity and somewhat less toxicity. The EGFR tyrosine kinase inhibitor gefitinib yields meaningful response rate and improvement in QoL in heavily pretreated patients, but has not been compared to other active agents or to best supportive care. Second-line treatment should be considered standard of care to fit patients, also outside of clinical studies.