Third-Line Chemotherapy in Advanced Non-small Cell Lung Cancer: Identifying the Candidates for Routine Practice

Abstract

Patients with advanced NSCLC may benefit from third-line treatment. The best candidates can be identified using standard prognostic factors, such as PS, and disease control after first- and second-line treatments.

Prevalence and effectiveness of first-, second-, and third-line systemic therapy in a cohort of unselected patients with advanced non-small cell lung cancer

“…p-Values were calculated using the Wald-method [18]. According to Girard et al [8] a stepwise selection method for the multiple logistic and Cox regression was used with an entry and exit p-value of 0.10 to identify significant prognostic factors. All tests were two-sided and conducted at the ˛ = 0.05 level, with a 95% CI.…”

“…Scartozzi et al [11] found no significant prognostic factors for DC after third-line, however the recent study by Girard et al [8] identified DC after second-line as being relevant. For TTP after third-line as outcome measure the only relevant factor was DC achieved after second-line therapy [11].…”

“…Two publications discussed prognostic factors for third-line therapy [8,11] and one publication integrated results from third and fourth-line [15]. Scartozzi et al [11] found no significant prognostic factors for DC after third-line, however the recent study by Girard et al [8] identified DC after second-line as being relevant.…”

“…However, no valid data exists on the effectiveness of therapy beyond second line [3], with the exception of one study with erlotinib [7]. Nevertheless, up to 50% of patients will receive further therapy after second-and also third-line therapy [4,8]. Since most pre-treated patients develop chemotherapy resistance, the regimen is usually switched to one with a different mode of action according to theoretical considerations but little scientific support [2].…”

“…For TTP after third-line as outcome measure the only relevant factor was DC achieved after second-line therapy [11]. For OS after third-line the only significant factor found by Scartozzi et al [11] and Girard et al [8] was DC achieved after second-line. Sample size was small in the study of Scartozzi et al [11] with 52 patients, therefore most evidence for the use of third-line therapy derives from Girard et al [8] with 173 patients.…”