Experience of first- and subsequent-line systemic therapy in the treatment of non-small cell lung cancer

Abstract

Abstract:Introduction: The treatment of advanced non-small cell cancer (NSCLC) has changed with multiple new treatment algorithms proposed based on histological and molecular subtyping but low mutation rates will ensure the dominance of cytotoxic chemotherapy. Accordingly, we undertook a detailed review of our practice delivering multiple lines of systemic therapy. Method: We undertook a retrospective review of consecutive patients presenting with advanced (stage IIIb/IV) NSCLC treated with systemic therapy at two UK hospitals during a 2-year period, January 2007 to December 2008. Results: A total of 130 patients were identified, treated with predominantly carboplatin/ gemcitabine (20 initially radically). Fifty of 110 patients (45%) treated with first-line systemic therapy subsequently received second-line therapy, of which 10 patients received third-line and two patients fourth-line therapy. Sixty three of 110 first-line patients (58%) achieved clinical benefit, 19 out of 50 (38%) in the second-line, 6 out of 10 (60%) in third-line but both patients progressed at fourth-line. Median overall survival for 110 patients was 10 months (95% confidence interval [CI] 8.611.4); but 16 months (95% CI 14-17.9) in those receiving multiple lines. Median survival from the first cycle of last-line treatment to death in the multiple therapy lines was 5 months (95% CI 2.6-7.3) and the majority of patients spent more time off treatment. Conclusion: Overall our outcomes are consistent with published data and show good survival times can be achieved. The future of advanced NSCLC is in selecting the best treatment approach on a histological and genotypic basis.

Non–Small Cell Lung Cancer, Version 5.2017, NCCN Clinical Practice Guidelines in Oncology

“…9,247,248 Patients often have a limited response to subsequent chemotherapy other than immune checkpoint inhibitors, although it may serve a useful palliative role. 249 The NCCN panel deleted erlotinib as an option for subsequent therapy for patients with squamous cell NSCLC based on a study comparing afatinib with erlotinib; this study was statistically significant but not clinically significant. 158 OS was slightly better in the afatinib group than in the erlotinib group (median OS, 7.9 months [95% CI, 7.2-8.7] vs 6.8 months [95% CI, 5.9-7.8]; HR, 0.81 [95% CI, 0.69-0.95]; P=.0077); however, almost 60% of patients in each arm had grade ≥3 AEs.…”

Epidemiological profile and prognostic factors in patients with lung cancer

“…In line with the literature, there are studies that show OS benefit using second and third lines, especially with molecularly targeted drugs. [26][27][28][29] As the laboratory variables, hemoglobin and LDH were related to survival in previous studies. 17,18 Our study did not establish this association as statistically significant; however, our sample is small compared with the literature and, also, we did not have data on all patients, and these factors may be responsible for any negative data.…”

Survival Analysis of Advanced Non–Small Cell Lung Cancer Patients Treated by Using Wheel Balance Cancer Therapy

“…After the first-line systemic therapy, 50 out of 110 patients received the second-line systemic therapy, of which 10 patients received the third-line and 2 patients received the fourth-line systemic therapy. 22 Thus, approximately 45% of the patients who received the first-line therapy subsequently received therapy again because of recurrent or progressive NSCLC.…”