gms | German Medical Science

Background: Second-line chemotherapy is recommended for recurring non–small-cell lung cancer (NSCLC). However, it is not yet established as common practise. Patients with NSCLC stage IIIB and IV who had received first-line paclitaxel/carboplatin chemotherapy within a phase III trial were studied in relation to their second-line chemotherapy.

Methods: 880 advanced NSCLC patients were assessed. They received first-line paclitaxel/carboplatin chemotherapy on a weekly or three-weekly schedule within a phase III trial. The study analysed the role in survival of factors such as schedule of first-line treatment, response to first-line treatment, gender and performance status.

Results: Out of 529 evaluated patients, 172 (32%) received second-line chemotherapy. Single-agent chemotherapy was given to 80 patients, while 92 patients received a combination of second-line chemotherapy. A survival advantage was seen with the multidrug chemotherapy. Most of the patients with performance status ECOG more than 2 received single-agent chemotherapy. The median survival was 9.7 months for multidrug chemotherapy versus 8.1 months for single-agent chemotherapy in the group of patients with progression to first-line chemotherapy. No difference in survival was observed depending on wether first-line treatment was administered on a weekly or three-weekly schedule.

Conclusion: Second-line chemotherapy in recurring NSCLC shows benefits to patients who responded to first-line chemotherapy with progression. Performance status should not be an exclusion criterion for further therapies, because patients with poor performance status showed benefits. Multidrug chemotherapy was seen to prolong survival more than single-agent chemotherapy.