Chemotherapy of advanced non-small cell lung cancer

Patients with advanced NSCLC receive palliative chemotherapy with platinum-based doublets. Cisplatin-based doublets are preferred in patients with good performance status, whereas carboplatin-based protocols are preferred in patients with impaired organ functions (kidney, heart). Customized chemotherapy appears promising but still remains experimental. Improvements of the outcome of first-line chemotherapy have been achieved by the addition of cetuximab in patients with EGFR-positive NSCLC and of bevacizumab in selected patients with non-squamous cell NSCLC. The optimal combination of chemotherapy with targeted therapies remains a challenge. Maintenance therapy and early second-line chemotherapy might improve outcome but are not yet considered as standard treatments. Patients progressing after first-line chemotherapy are treated with docetaxel, pemetrexed or erlotinib. Finally, the efficacy of new anticancer treatments should be assessed by several clinical endpoints with overall survival remaining the most important endpoint in patients with advanced NSCLC.