Second-line therapy for lung cancer – which is most effective?

This study investigated second-line treatments for non-small cell lung cancer (NSCLC). They found that second-line options are effective in advanced NSCLC.

Non-small cell lung cancer (NSCLC) is the most common type of lung cancer. Many cases of NSCLC are diagnosed at an advanced stage. First-line treatment involves standard chemotherapy and radiation. The prognosis is poor for patients that do not respond to first-line treatments.

New drugs are in development to treat advanced cancer. Some drugs target certain genes expressed by cancer cells. PD-1/PD-L1 inhibitors are one of type. They block a pathway that cancer cells use to avoid the immune system. Some new drugs target abnormal genes that allow cancer cells to grow at a rapid rate. Some drugs target epidermal growth factor receptor (EGFR) mutations. This can slow cancer growth. Other drugs may be effective depending on the cancer histology (size and shape). Choosing an effective second-line treatment for advanced NSCLC is important. It is unclear which second-line treatment is most effective in advanced NSCLC.

This study reviewed 30 clinical trial reports. 17 different treatment regimens were used in these studies. The effectiveness of treatments was compared to docetaxel (Taxotere). This is a standard chemotherapy drug. Survival rates were evaluated.

Docetaxel in combination with ramucirumab (Cyramza) was effective in all patients. Ramucirumab is a drug that reduces blood supply to cancer cells. Docetaxel in combination with nintedanib (Ofev) was effective in non-squamous NSCLC. Nintedanib reduces blood supply to cancer cells. Drugs that block EGFR were effective in patients with EGFR-positive tumors. Nivolumab (Opdivo; a PD-1 inhibitor) was effective in cancers with high PD-L1 expression.

The authors concluded that various second-line treatment options are effective in patients with advanced NSCLC.

The study designs varied considerably. Only 3 studies with PD-L1 inhibitors were included. More investigation is needed to determine which second-line therapies are most effective.

If you have any concerns regarding lung cancer treatment, please consult with your oncologist.