Third-line therapy for advanced non-small-cell lung cancer patients: feasible drugs for feasible patients

Abstract

The proven benefit of third-line treatment in advanced non-small cell lung cancer (NSCLC) is still unclear. We retrospectively evaluated the outcome of advanced NSCLC patients treated with third-line therapies in our institution, especially focusing on efficacy and toxicity between mono-therapy and doublets chemotherapy, aiming to assess the value of third-line treatment and evaluate the efficacy of different regimens in third-line treatment. Three hundred and seventeen patients received a second-line treatment among 620 advanced NSCLC after failure of first-line chemotherapy. One hundred and twenty-six patients from this group were offered third-line or further-line treatments. Survival analysis was conducted based on Kaplan-Meier method, and Chi-square was used to compare data between second-line and third-line group. There were significant differences in overall survival between second-line and third-line treatments (17.70 months vs. 24.03 months, P < 0.0001). Twenty-four patients received single chemotherapy, epidermal growth factor tyrosine kinase inhibitors (EGFR-TKIs) were used to treat thirty-three patients and sixty-nine patients received doublet chemotherapy in third-line treatment. The progression-free survival (PFS) after third-line therapy was 2.37 months in all patients and 2.30 months, 2.80 months, 2.97 months, in the doublet chemotherapy, single-agent chemotherapy, and EGFR-TKIs arms, respectively (P = 0.033). Cancer-related symptom relief improvement was confirmed in 78.9% patients (60/78). Forty-eight patients had no symptoms as confirmed by imaging examination. Patients with advanced NSCLC could get benefits from third-line treatments. Those patients could obtain a moderate progression-free survival and conspicuous improvement in the cancer-related symptom. Mono-therapy was recommended in third-line treatment.

Efficacy and safety of apatinib plus docetaxel as the second or above line treatment in advanced nonsquamous NSCLC

“…[1] Non-small cell lung cancer (NSCLC) accounts for about 80% of lung cancer occurring in all patients, [2] which is mostly at the advanced stage upon diagnosis, with the median survival of less than 1 year. [3] Studies revealed the beneficial effect of chemotherapy and targeted therapy in a portion of NSCLC patients who experienced refractory first/second line treatment, [4–6] but there lacks a standard third-line therapy regimen.…”

Pemetrexed in Third and Fourth Line Chemotherapy for Non Squamous Non Small-Cell Lung Cancer

“…The authors quated like candidates for third-line chemotherapy: single-agent gemcitabine, irinotecan, and oral topotecan [8]. The study published by Song et al was a retrospective study which confirmed the small but proved benefit of third-line chemotherapy.treated with doublet of cytostatics, 2.80 months for single-agent and 2.97 months for EGFR-TKIs arms (P=0.033) [9]. One of the first studies which tested the use of pemetrexed in thirdline chemotherapy for advanced NSCLC was a retrospective study of Jong-Mu et al In this study, the medical records of NSCLC patients who received pemetrexed therapy that progressed after systemic therapy were reviewed retrospectively.…”

A Phase II Study of Amrubicin as a Third-Line or Fourth-Line Chemotherapy for Patients With Non-Small Cell Lung Cancer: Hokkaido Lung Cancer Clinical Study Group Trial (HOT) 0901

“…The lower end of the 95% CI in the present study was higher than the threshold DCR of 30%, and the primary endpoint was met. Single-agent chemotherapy and EGFR TKI therapy had advantages over doublet chemotherapy in prolonging PFS and decreasing toxicity when used in thirdline therapy [26]. In a BR.21 trial, erlotinib demonstrated survival benefits when administered as a second-or third-line therapy, compared with placebo (OS, 6.7 months vs. 4.7 months, respectively) [7].…”