Advanced non-small cell lung cancer. Maintenance and second-line treatment

Maintenance and second-line treatment of locally advanced or metastatic non-small cell lung cancer (NSCLC) have become a standard of care. Optimal conditions for maintenance treatment are both specific analysis of tumor histology and choice of first-line treatment. This includes evaluation of EGFR mutation status, histology of the tumor, and response to first-line treatment. Immediately after first-line therapy continuous as well as switch maintenance treatment are available so far. When patients express a preference, the indication has to be considered. Chemotherapy agents of continuous treatment are pemetrexed and docetaxel as well as tyrosine kinase inhibitors, bevacizumab, and cetuximab. Recommendations in the second-line setting are pemetrexed, docetaxel, or erlotinib as the standard. The choice of second-line treatment depends on first-line therapy and their toxicities. After first-line therapy with a tyrosine kinase inhibitor platinum-based chemotherapy with a taxane is indicated. By carefully considering treatment and patient characteristics, the therapeutic procedure has become a distinctly improved setting due to the development of new therapeutic possibilities in recent years.