Treatments for when lung cancer progresses

This review discussed the use of nintedanib (Vargatef) in non-small cell lung cancer that has progressed despite treatment.

Non-small cell lung cancer (NSCLC) is often not diagnosed until the disease is advanced (spread to the lymph nodes or other areas of the body). Chemotherapy is the first-line treatment, but the disease progresses in roughly 30% of patients. The development of targeted therapies (treatments that target the molecular causes of NSCLC) have led to improved survival rates. Bevacizumab (Avastin), for example, targets the vascular endothelial growth factor (VEGF) pathway (involved in tumor growth), and has been approved as a first-line therapy in NSCLC. However, patients often become resistant to bevacizumab. Therapies that target more than one growth pathway are needed.

Nintedanib is a therapy that targets three different NSCLC growth pathways. Nintedanib is approved in the European Union for use as a second-line treatment in combination with docetaxel (Taxotere) in patients with advanced NSCLC.

A large (1314 patients) study compared the combination of nintedanib and docetaxel to a placebo (substance with no therapeutic effect) and docetaxel. All patients had NSCLC that had spread to the lymph nodes or other areas of the body and had disease progression following chemotherapy. Patients were followed for an average of 31.7 months.

Treatment with nintedanib reduced the risk of disease progression by 23% compared to placebo. In patients with early progression (within 9 months of the first chemotherapy), nintedanib reduced the risk of progression by 37%.

Overall survival (time from treatment until death from any cause) was increased by 3 months in the early progression patients, and by 2.3 months in all patients. 52.7% of patients treated with nintedanib were alive after 1 year compared to 44.7% treated with placebo.

Adverse (negative) side effects were similar between the two groups. The most common side effects in those treated with nintedanib were diarrhea, vomiting and abnormal liver function.

This study concluded that the combination of nintedanib and docetaxel is an effective treatment for advanced NSCLC patients who have progressed despite chemotherapy.