[First-line treatment of metastatic non-small cell lung cancers]

The first-line treatment of non-small cell bronchial cancers at the metastatic stage relies on chemotherapy, the impact of which, in terms of survival in comparison with palliative care alone, has been confirmed by several meta-analyses. The recent development of new drugs (vinorelbine, gemcitabine, paclitaxel, docetaxel) that benefit from an improved efficacy-toxicity ratio, has led to the individualisation, as treatment standard in patients in a general state of good health, of bitherapies based on the combination of a platinum salt and recent active drugs. The latter exhibit similar efficacy, in terms of response and survival, providing PS 0 or 1 patients with a median survival of around 8 months and, at 1 year, nearing 35%. The choice of the first-line therapy in a given patient will be based essentially on the differences in toxicity profiles among the therapeutic regimens, taking into account the frequent co-morbidities in this population, the modalities of administration and the perspectives of second-line therapy. The patients with an altered general state of health (PS 2) will benefit from adapted treatment based on active monotherapy or bitherapy without cisplatin. The prolongation of the first-line therapy over and above 4 cycles following maximal reduction of the tumour does not provide enhanced survival and considerably increases toxicity. The recent cytotoxic agents appear to provide a real progress, although modest in the treatment of metastatic NSCBC, progress which is visible considering the proportion of patients still living in the long term.