Traitement de seconde ligne et au-delà des cancers bronchopulmonaires non à petites cellules de stade IV en l'absence d'addiction oncogénique

During the last decade, post-platinum treatment options in advanced non-small cell lung cancer without oncogenic addiction have been restricted to docétaxel, pémétrexed or erlotinib, providing modest results. Several new therapeutic options have been recently developed, leading to deeply change the treatment algorithm after the first line of treatment. The addition of an antiangiogenic agent to docétaxel demonstrated an improvement of overall survival with limited toxicities for nintedanib in adenocarcinoma and ramucirumab for both squamous and non-squamous cell carcinoma. Afatinib has shown superiority over erlotinib in second-line treatment of squamous cell carcinoma in terms of progression-free and overall survival. Immune checkpoints inhibitors targeting the interaction between Program Death Receptor 1 (PD1) on T cells and its ligand PD-L1 expressed on tumor cells demonstrated a survival benefit comparatively with docétaxel, with a better safety profile and durable responses leading to expect long-term survival. However, responses to single agent anti-PD1 or PD-L1are observed only for a minority of patients, requiring predictive biomarkers. The correlation between the magnitude of survival benefit and the level of PD-L1 expression by non-squamous carcinoma cells leads to take this factor into account for the treatment decision process in 2nd line and soon in first-line therapy.