Title:Second-line Treatment of Advanced Non-small Cell Lung Cancer Non-oncogene Addicted: New Treatment Algorithm in the Era of Novel Immunotherapy
VOLUME: 13 ISSUE: 2
Author(s):Cesare Gridelli*, Paolo Antonio Ascierto, Francesco Grossi, Editta Baldini, Adolfo Favaretto, Maria Chiara Garassino, Alessandro Morabito, Maria Rita Migliorino, Antonio Rossi and Filippo de Marinis
Affiliation:Division of Medical Oncology, "S. G. Moscati" Hospital, Avellino, Unit of Melanoma, Cancer Immunotherapy and Development Therapeutics Istituto Nazionale Tumori Fondazione G. Pascale, Napoli, Lung Cancer Unit, IRCCS AOU San Martino-IST Istituto Nazionale per la Ricerca sul Cancro, L.go R. Benzi 10, 16132 Genova, Department of Medical Oncology, Medical Oncology Div. S. Luca Hospital, Lucca, Departement of Medical Oncology, Ospedale Ca` Foncello, AULSS 2, Marca Trevigiana, Treviso, Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Thoracic Medical Oncology, Istituto Nazionale Tumori, Fondazione G. Pascale - IRCCS, Napoli, Pulmonary Oncology Unit, San Camillo-Forlanini Hospital, Rome, Division of Medical Oncology, IRCCS Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo (FG), Thoracic Division, Medical Oncology Department, European Institute of Oncology, Milan
Keywords:Antiangiogenetics, chemotherapy, immunotherapy, non-small cell lung cancer, second-
line treatment, epidermal growth factor receptor.
Abstract:Background: Most patients with advanced non-small cell lung cancer (NSCLC) have a
poor prognosis and receive limited benefit from conventional treatments, especially in later lines of
therapy. In recent years, several novel therapies have been approved for second- and third-line
treatment of advanced NSCLC beyond old chemotherapy agents (docetaxel and pemetrexed) and
the epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKI, erlotinib). In particular,
the new antiangiogenetics (nindetanib and ramucirumab) in combination with docetaxel and
immunotherapy (nivolumab, pembrolizumab and atezolizumab) have been recently approved and
represent new treatment options.
Methods: The Italian Association of Thoracic Oncology (AIOT) organized five meetings in different
Italian regions representing North, Middle and South of the country in order to discuss the issue.
Results: In light of these new approvals, it is valuable to understand the uptake of these new therapies
in routine clinical practice and their impact on patient care. With these treatment options to
define an appropriate algorythm is object of debate.
Conclusion: The present paper discusses the old and new treatment opportunities, proposing a
shared algorithm for second-line setting in advanced NSCLC.
