From 2000 to 2016: Which Second-Line Treatment in Advanced Non-Small Cell Lung Cancer?

Area of Science:

• Oncology
• Medical Treatment

Background:

• Second-line treatment options for EGFR wild-type and ALK-negative non-small cell lung cancer (NSCLC) have expanded.
• New immunotherapies and antiangiogenic agents are now available.

Purpose of the Study:

• To identify patient subgroups eligible for different second-line therapy sequences in NSCLC.
• To provide selection criteria beyond PD-L1 expression for nintedanib, ramucirumab, nivolumab, and pembrolizumab.

Main Methods:

• Review of current second-line treatment options for NSCLC.
• Analysis of clinical criteria including performance status, smoking, comorbidities, histotype, platinum resistance, and progression speed.
• Identification of subgroups for distinct therapeutic sequences.

Main Results:

• Clear selection criteria are lacking for most NSCLC patients, except those with PD-L1 expression ≥50% for certain immunotherapies.
• Clinical factors such as performance status, smoking history, and comorbidities are important.
• Tumor characteristics like histotype, platinum resistance, and rapid progression influence treatment choice.

Conclusions:

• Personalized selection criteria are needed to optimize second-line treatment sequences for EGFR wild-type, ALK-negative NSCLC.
• Integrating clinical and tumor characteristics can guide the use of new agents like nintedanib, ramucirumab, nivolumab, and pembrolizumab.
• Further research is warranted to refine treatment algorithms for NSCLC.