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.