The role of pemetrexed in second-line chemotherapy for advanced non-small cell lung cancer

Despite improvements in first-line therapy for advanced NSCLC all patients with metastatic disease will progress at some point. Patients with favorable prognostic factors such as good performance status, non-squamous histology, stable weight, and perhaps female gender are more likely to receive second-line chemotherapy. Currently the United States FDA recognizes three single agents (docetaxel, erlotinib, and pemetrexed) as established for providing a benefit in patients who have experienced progression after first-line therapy. This review focus on the role of PEM in the treatment of advanced NSCLC in patients who have experienced disease progression during or after first-line therapy. The multi-targeted antifolate pemetrexed is equivalent to docetaxel for second-line therapy and with less toxicity.