Carcinome bronchique non à petites cellules : quelle chimiothérapie de rattrapage ?

Second and third line treatment in metastatic non-small cell lung cancer is a standard of care. Docetaxel, pemetrexed and erlotinib have demonstrated their effectiveness with an improvement of global survival and quality of life and are currently approved in this setting. Histology is a key decision-making factor in the choice among these drugs. Indeed, pemetrexed is more effective in non-squamous histology compared to squamous histology. Except the situation of oncogenic addiction which will not be addressed in this paper, no other clinical or biological factor strongly predicts the effectiveness of these drugs. The modest survival benefit obtained has led to explore new therapeutic options. Ramucirumab is an antiangiogenic drug which has demonstrated a significant improvement of overall survival in second-line treatment in combination with docetaxel compared to docetaxel alone in a large randomized phase III trial including unselected non-small cell lung cancer. These results could lead to an approval of ramucirumab in the setting.