[Second-line treatment for advanced non-small-cell lung cancers]

Recent trials indicate that several new chemotherapy agents may be useful for the treatment of non-small cell lung cancers (NSCLCs) refractory to, or recurring following platinum-based chemotherapy. Two phase III trials have established docetaxel as the first chemotherapeutic agent with proven benefit for patients with recurrent or refractory disease following initial chemotherapy. Several other new drugs including gemcitabine have been tested by phase II studies. Treatment with pemetrexed resulted in outcomes with clinically equivalent efficacy, but with significantly fewer side effects compared with docetaxel in two phase III trials. It should be considered a standard treatment option for second-line treatment when available. EGF receptor tyrosine kinase inhibitors including gefitinib and erlotinib have benefits as second-line chemotherapy for NSCLCs. Symptom relief, improvement of QOL, and minimum toxicity as well as survival benefit have to be evaluated in phase III trials in order to develop a new second-line chemotherapy.