​Efficacy and Toxicity Profile of Various Second-line Chemotherapeutic Drugs in Stage III and Stage IV Non-small Cell Lung Cancer

ABSTRACT

Introduction: The majority of patients with non-small cell lung cancer (NSCLC) present with advanced stage disease – StageIV, in particular, and half of the patients treated initially for the potentially curable early-stage disease will recur with metastaticdisease. This is true even in developed countries. Patients with Stage IV disease are never curable, and chemotherapy, targetedtherapy, and radiation can extend survival and palliate symptoms.Aim: The aim of this study was to assess the clinical efficacy of various drug regimens used as the second-line chemotherapyin NSCLC and to assess the various toxicity profile of the second-line therapeutic agents used in NSCLC.Materials and Methods: Patients with locally advanced non-small cell lung cancer exposed to first-line chemotherapy wereselected for one of the second-line treatment regimens (carboplatin + gemcitabine, carboplatin + pemetrexed, docetaxel,gemcitabine, and gefitinib) based on age, performance status (PS), and histopathology. All regimens were planned for amaximum of 4 cycles except gefitinib which was given until progression. The response was assessed by computed tomographychest scan using response evaluation criteria in solid tumor criteria 1.1 and toxicity was assessed using common terminologycriteria for adverse events 4.03.Results: Of 50 patients, nine patients received carboplatin/gemcitabine, 14 patients received carboplatin/pemetrexed, 11 patientsreceived docetaxel, 10 patients received gemcitabine, and 6 patients received gefitinib. Of five arms, patients who had docetaxelshowed an improvement in Eastern Cooperative Oncology Group (ECOG) PS, but the observation was not statistically significant.This study had observed that none of the second-line regimens were superior to others, but patients who received docetaxelhad shown improvement in ECOG PS.Conclusion: In NSCLC patients who progressed on first-line chemotherapy, all five regimens used in the study were equallyefficacious.