Management strategies for recurrent non-small cell lung cancer

Because the benefit of first-line chemotherapy for non-small cell lung cancer (NSCLC) may be marginal, the use of chemotherapy in the second-line setting for the patient who has failed primary platinum-containing chemotherapy (PCC) is similarly debatable. The most experience with second- line chemotherapy for NSCLC is with docetaxel. Two identical studies enrolled 88 good performance status (PS) patients with NSCLC resistant or refractory to prior PCC. The partial response rate was 17%, median survival was 39 weeks, and the 1-year survival rate was 40% (compared with historical controls who had median and 1-year survivals of 16 weeks and 16% [P = .003]). Second-line activity of paclitaxel is less clearly defined: three trials are negative, two are equivocal, and one is positive. Comparison of these studies is difficult, however, because of varying drug doses/schedules, small sample sizes, and/or incomplete data. Median and 1-year survivals (available in two studies) were 17 weeks and 16%. Other agents active against NSCLC have been disappointing in the second-line setting, including vinorelbine, irinotecan, vindesine, mitomycin, and etoposide. In conclusion, docetaxel (and perhaps paclitaxel) may offer some benefit to NSCLC patients whose disease has failed initial PCC. However, the routine use of second-line chemotherapy with a taxane should probably be limited to patients with PS of 0 or 1 only.