Unanswered questions: monoclonal antibodies in the treatment of advanced non-small-cell lung cancer.

First-line platinum-based doublets is established as the standard of care for advanced non-small-cell lung cancer (NSCLC). Nevertheless, in this field a plateau of effectiveness has been reached during the last years. One new area of exploration in NSCLC therapeutics lies in the use of tyrosine-kinase inhibitors (TKIs) or monoclonal antibodies (mAbs) to target vascular endothelial growth factor (VEGF) and its receptors, and epidermal growth factor receptor (EGFR). The results of randomized trials testing mAbs against VEGF (bevacizumab) and EGFR (cetuximab) are challenging the paradigm of the platinum doublets as the gold standard in advanced NSCLC. Despite the interesting results that have thus far been collected, the benefit of these new agents, both in terms of balancing between advantages and toxicity and the associated health economic burden, is modest. Here we discuss the use of bevacizumab and cetuximab, the mAbs for which the largest amount of data in the treatment of advanced NSCLC exists. However, despite our having a significant amount of data on these two mAbs, we still have much to learn: Which patients are appropriate for these treatments; for how long are the treatments beneficial, and what are the molecular and clinicalpredictors? We must continue to study these important problems in treating NSCLC.