Advanced non-small cell lung cancer: Subsequent systemic therapy for previously treated patients
- Rogerio C Lilenbaum, MD, FACP
Rogerio C Lilenbaum, MD, FACP
- Section Editor — Lung Cancer
- Yale Cancer Center
Initial systemic therapy (chemotherapy or targeted agents) may delay disease progression and prolong survival in patients with advanced non-small cell lung cancer (NSCLC). However, almost all patients eventually develop progressive disease requiring further treatment.
Advances in the use of chemotherapy, targeted agents, and immunotherapy have led to the sequential use of multiple lines of therapy. The choice and sequence of subsequent therapies will be presented here.
The initial management of advanced NSCLC is presented separately. (See "Overview of the treatment of advanced non-small cell lung cancer".)
Further details regarding the rationale and data supporting the use of immunotherapy and targeted therapies are discussed elsewhere:
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- GOALS OF TREATMENT
- PRETREATMENT ASSESSMENT
- NO DRIVER MUTATION PRESENT
- Suggested sequence of therapies
- - Immunotherapy
- - Single-agent chemotherapy
- DRIVER MUTATION PRESENT
- SELECTION OF SINGLE-AGENT CHEMOTHERAPY
- Approach based on histology
- Efficacy and toxicities
- - Docetaxel
- - Pemetrexed
- - Ramucirumab plus docetaxel
- - Gemcitabine
- DURATION OF TREATMENT
- SPECIAL CONSIDERATIONS
- Older and medically complicated patients
- Retreatment after initial response
- Relapse after definitive therapy
- Local management of metastases
- PROMISING INVESTIGATIONAL STRATEGIES
- New inhibitors of molecular targets
- Proteomic signature assay
- THERAPIES TO BE AVOIDED
- Chemotherapy plus a tyrosine kinase inhibitor
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS