Use of novel second-line targeted therapies in non-small cell lung cancer.

Non-small cell lung cancer (NSCLC) is the leading cause of cancer death in the United States and throughout the world. This is largely because more than half of lung cancer cases present as metastatic disease, making local therapy for cure impossible. The last decade has seen significant improvement in first-line treatment of NSCLC, including the use of new chemotherapeutic agents with more effective therapeutic profiles. However, standard cytotoxic regimens are still limited and it remains critical to better understand and develop new treatment options for refractory disease. This has included some new second-line therapeutic approaches and has led to a focus on molecular targeted therapy, including agents that block the epidermal growth factor receptor (EGFR) or angiogenesis. EGFR-targeted agents such as gefitinib, erlotinib, and cetuximab have been successfully used for NSCLC treatment, with studies reporting overall response rates of 18.4%, 8.9%, and 3.3%, respectively. Angiogenesis inhibitors such as bevacizumab and ZD6474 have also improved treatment outcome. Bevacizumab had an overall response rate of 27% when used in combination with paclitaxel and carboplatin, and ZD6474 had an overall response rate of 26% when used in combination with docetaxel. Using these compounds alone or in combination may improve the survival and quality of life of patients with lung cancer in the refractory setting.