Second-line chemotherapy and beyond for non-small-cell lung cancer

Platinum-based chemotherapy is now established in the treatment of all stages of lung cancer. Despite the benefits of therapy, the majority of patients treated for lung cancer will ultimately progress. Some will retain good performance status and be candidates for additional, tumor-directed treatment. Docetaxel and pemetrexed have documented activity in phase III trials in patients progressing after first-line, platinum-based therapy. Gefitinib has recently been approved for treatment of disease in the third line. Numerous other agents with diverse mechanisms are currently undergoing evaluation in this setting. This review evaluates the population eligible for such treatments and discusses recent trials in second and subsequent lines of therapy.