Is second-line systemic chemotherapy beneficial in patients with non-small cell lung cancer (NSCLC)? A multicenter data evaluation by the Anatolian Society of Medical Oncology

Abstract

Patients with advanced non-small cell lung cancer (NSCLC) generally require second-line treatment although their prognosis is poor. In this multicenter study, we aimed to detect the characteristics related to patients and disease that can predict the response to second-line treatments in advanced NSCLC. Data of 904 patients who have progressed after receiving first-line platinum-based chemotherapy in 11 centers with the diagnosis of stage IIIB and IV NSCLC and who were evaluated for second-line treatment were retrospectively analyzed. The role of different factors in determining the benefit of second-line treatment was analyzed. Median age of patients was 57 years (range 19-86). Docetaxel was the most commonly used (20.9 %, n = 189) single agent, while gemcitabine-platinum was the most commonly used (6.7 %, n = 61) combination chemotherapy regimen in second-line setting. According to survival analysis, median progression-free survival after first-line treatment (PFS2) was 3.5 months (standard error (SE) 0.2; 95 % confidence interval (CI), 3.2-3.9), median overall survival (OS) was 6.7 months (SE 0.3; 95 % CI, 6.0-7.3). In multivariate analysis, independent factors affecting PFS2 were found to be hemoglobin (Hb) level over 12 g/dl and treatment-free interval (TFI) longer than 3 months (p = 0.006 and 0.003, respectively). Similarly, in OS analysis, Hb level over 12 g/dl and time elapsed after the first-line treatment that is longer than 3 months were found to be independent prognostic factors (p = 0.0001 and 0.045, respectively). In light of these findings, determining and using the parameters for which the treatment will be beneficial prior to second-line treatment can increase success rate.

First and Second Line Chemotherapeutic Regimens for Non-Small Cell Lung Carcinomas - The Efficacy of Platinum, Non-Platinum and Combination Therapy: A Literature Review

“…The articles analyzed the efficacy of platinum, non-platinum or combination therapeutic regimens while also advocating towards specific treatment modalities. Nine studies advocate for combination therapy as an effective treatment regimen for first-line NSCLC [7][8][9][10][11][12][13][14][15], five studies advocate towards non-platinum based therapy as an effective and safer regimen [8,[16][17][18][19], one study concludes that non-platinum based therapy is an effective regimen compared to combination therapy in first-line NSCLC [20], two studies conclude that both non-platinum based regimens and combination therapy show an equal efficacy [21,22], three therapies indicate similar efficacy between platinum-based and non-platinum based regimens [23][24][25], two therapies indicate that the efficacy of non-platinum based therapy is similar to the efficacy of other treatment regimens [26,27], one study states that platinum-based regimens showed a higher efficacy and response rate than non-platinum based regimens [28], 12 studies advocate for non-platinum based regimens as a second line treatment regimen [29][30][31][32][33][34][35][36][37][38][39][40], and two studies advocate towards combination therapy for second-line treatment [41,42]. Most of the articles lean towards the use of combination therapy for first-line treatment and non-platinum based therapy for second-line treatment.…”

“…Overall, in terms of first-line treatment, we found nine articles that advocate for combination therapy and they comprise the following study designs: retrospective cohort study [7], randomized clinical trial [8], randomized control trial [10], case control study [11], randomized clinical trial [12], randomized control trial [13], observational study [14], review article [15]; five articles advocate for non-platinum regimens and they comprise the following study designs: randomized clinical trial [8], review article [16], observational study [17], randomized clinical trial [18], randomized clinical trial [19]; one article (retrospective cohort study [28]) advocates for the use of non-platinum based therapy over combination therapy.…”

Response to: Second-Line Treatment of Non-Small-Cell Lung Cancer with Wild-Type EGFR Status. What Is the Best Approach?

“…A very valid point was raised concerning the concept of treatment-free interval as reported by Odabas et al 4 We will consider re-evaluating our published results to determine if that parameter did indeed affect the success rate of second-line treatment in our study population.…”

Rescue Therapy in Patient with NSCLC with the Combination of Chemotherapy and Hyperthermia

“…It is difficult to get a remission after the second line drug therapy [1]. In this article carry over the experience with a man which has obtained disease response with the fifth therapeutic line.…”