Non-small-cell lung cancer progression after first-line chemotherapy |
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Authors: | Lara Primo N Lau Derick H M Gandara David R |
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Institution: | (1) Division of Hematology-Oncology, Department of Internal Medicine, University of California Davis Cancer Center, 4501 X Street, 95817 Sacramento, CA, USA |
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Abstract: | Opinion statement Platinum-based chemotherapy is the cornerstone of care for patients with metastatic non-small-cell lung cancer (NSCLC). It
provides symptom relief, improved quality of life, and prolongation of life, compared with supportive care alone. However,
all patients with stage IV disease inevitably develop resistance to chemotherapy and progressive disease. Many of these patients
continue to have acceptable performance status and would therefore be eligible for second-line or even third-line treatments.
Unfortunately, despite an increasing number of chemotherapeutic agents (which are effective in chemo-naive NSCLC), very few
have been shown to have reproducible activity in the second-line setting. Nevertheless, recent randomized clinical trials
have demonstrated that single-agent docetaxel improves survival and quality of life when delivered as second-line therapy,
resulting in FDA-approval for this indication. Phase II studies evaluating other new agents, delivered singly or in combination,
also have reported that gemcitabine, weekly paclitaxel, and the epidermal growth factor receptor (EGFR) inhibitors are active
in a subset of patients who progress after first-line platinum-based therapy. Clinical trials are imperative in identifying
additional new agents and approaches that may improve outcomes in this disease. In view of the recently established role of
docetaxel, ongoing randomized studies are using a common design of single-agent docetaxel versus docetaxel plus a novel investigational
agent. |
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