Quel traitement en deuxième ligne métastatique des cancers bronchiques non à petites cellules ?

In Europe and the United States, the current options for the second line treatment of advanced non-small cell lung cancer (NSCLC) are cytotoxic drugs and targeted agents. Docetaxel was the first drug approved for second-line treatment after two phase III trials demonstrated its superiority over best supportive care (BSC) alone and single-agent chemotherapy. Pemetrexed was also registered for use as second-line therapy after it was demonstrated to have a similar efficacy and a more favourable toxicity profile than docetaxel. Erlotinib, an epidermal growth factor receptor inhibitor, was approved after showing its superiority over BSC as second/third line treatment in NSCLC patients. This review focuses on these drugs, dealing with the results that aid the choice between docetaxel, pemetrexed, and erlotinib in second line treatment. We also discuss the currently available preliminary data about early second-line treatment i.e. maintenance treatment immediately following the first line with non cross-resistant agents different from those included in the induction regimen.