Second line in NSCLC: new opportunities?

Every patient affected by advanced and recurrent NSCLC, despite modest outcome benefits from first-line therapy, experiences disease progression and requires salvage therapy. In second-line settings, only a small percentage of patients, in other words, those with oncogene-addicted NSCLC, can benefit from specific inhibitors if still not received at first line, and another small percentage may be enrolled in clinical trials.  However, most ‘real-life population’ patients are molecularly unselected or ineligible for clinical trials and receive standard second-line therapy. We will discuss specifically this large group of patients.

Since 2000, when two randomized trials demonstrated that docetaxel improved overall survival (OS), symptom control and quality of life (QoL) compared with best supportive care and with vinorelbine or ifosfamide, the second-line approach became a standard of care [1,2]. It was the first scientific evidence that a salvage therapy worked, and this was considered another step forward in the fight against NSCLC, despite docetaxel showed more neutropenia and febrile neutropenia compared with the control arm.

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