Second line treatments in advanced platinum-resistant non small cell lung cancer. A critical review of literature.

In the last 10 years the medical approach to platinum-resistant Non Small Cell Lung Cancer (NSCLC) has radically changed, passing from a lack of evidence of any primary treatment against the tumor, to the identification of chemotherapy or EGFR inhibitors as the gold standard for clinical practice. Eight randomized clinical trials support the evidence of efficacy of second-line treatments against NSCLC, and docetaxel, pemetrexed and erlotinib are the most effective options for clinical practice. However, many aspects remain still undefined: Can a treatment with docetaxel, pemetrexed or erlotinib be considered the gold standard for all patients with platinum-resistant NSCLC, and consequently should all patients be treated with at least one of these options? Are the benefits enough to justify the side effects observed with these chemotherapeutic options? Can a schedule be preferred to the others for either efficacy or safety profile? Can the new EGFR inhibitors be considered an innovation in the treatment of platinum-resistant NSCLC, and should they be used in all patients with platinum-resistant NSCLC? A systematic review of randomized clinical trials and a critical analysis of the results were performed with the aim to clarify the real meaning of medical treatments in advanced, platinum-resistant NSCLC.