[Stage IV NSCLC. Second-line therapy for metastatic non-small cell lung cancer]

Second line chemotherapy for advanced non small cell lung cancer is a recent concept as the first phase III studies demonstrating its efficacy were published in 2000. Docetaxel was the first agent explored and deemed efficient in this setting at the dose of 75 mg/m2 every 3 weeks. Then pemetrexed was compared to docetaxel in a non-inferiority randomized trial at the dose of 500 mg/m2 every 3 weeks and demonstrated similar efficacy with significantly less toxicity than docetaxel. Targeted therapies undergo exponential development in the treatment of non-small cell lung cancer and the small molecule erlotinib (at a dose of 150 mg/day per os) which inhibits the tyrosine kinase of EGF-R demonstrated a significant benefit of survival compared to placebo in second or third line of chemotherapy. At this time there is no specific recommendations for further lines of chemotherapy although in clinical practice, they are currently used in good performance status patients.