Second-line chemotherapy in relapsing or refractory patients with non-small cell lung cancer

Purpose: A comprehensive review of the literature on the efficacy of antitumor agents either alone or in combination as second-line chemotherapy in advanced non-small cell lung cancer (NSCLC) cancer was undertaken. Results: An increasing number of patients with advanced NSCLC who progress or fail to respond to front-line chemotherapy are young and in good performance status, requiring further treatment. Since advanced NSCLC is an incurable and fatal disease, the aims of second-line chemotherapy should be the palliation of the symptoms and, probably, the improvement of survival. Docetaxel, gemcitabine, irinotecan and paclitaxel have shown a promising activity as second-line treatment in patients with NSCLC, and several phase II studies of regimens associating either these drugs or these drugs with CDDP and ifosfamide have shown objective responses ranging from 15 to 25% and a median survival ranging from 4 to 8 months. Two randomized trials have clearly demonstrated that single agent docetaxel in the second line setting confers a survival benefit and an improvement of both the quality of life and the control of tumor-related symptoms establishing, thus, the role of docetaxel as standard treatment for relapsing or refractory patients with NSCLC. Conclusions: Increasing evidence from both phase II and III studies seems to indicate that second-line chemotherapy may confer a survival benefit in a selected group of patients with advanced NSCLC.