[NSCLC: update on second line therapy following ASCO 2007]

Since the year 2000 second line therapy for pre-treated non-small cell lung cancer patients has been established. There are currently two chemotherapeutic agents - docetaxel (Taxotere) and pemetrexed (Alimta) - which have been approved for second line treatment in Austria in addition to the tyrosinkinase-inhibitor erlotinib (Tarceva). In randomised trials these agents have shown a clear advantage over best supportive care in pre-treated patients in terms of overall survival and quality of life. However, these compounds also cause considerable drug-specific toxicities. Therefore there is an urgent need for new treatment options with higher efficacy and a lower burden of toxicity. At ASCO 2007, results of randomised trials were presented concerning new chemotherapeutic agents, such as vinflunine as well as targeting agents such as gefitinib, without affecting outcome. Another trial comparing a standard dose of pemetrexed with a higher dose also showed no improvement in outcome. A comparison of immediate application with delayed application of docetaxel after primary treatment demonstrated improved progression-free survival in selected patients in the immediate study arm but this did not translate to a survival benefit. The results of these trials may add further treatment options to the present portfolio of agents and concepts in this setting and give some optimism for the near future. At present, no changes need to be made in the options for standard second-line treatment of NSCLC in view of the results presented at ASCO 2007.