Klin Farmakol Farm. 2015;29(1):16-21

Management of advanced non-small cell lung cancer

Milada Zemanová

Onkologická klinika 1. LF UK a VFN Praha

Lung cancer is the leading worldwide cause of cancer death and the majority of patients present with metastatic stage IV disease. Palliative

systemic therapy is the main choice in metastatic stage. Different treatment strategies exist according to squamous or non-squamous

histology or molecularly defined markers in non-small-cell lung cancer. Molecular testing for at least epidermal growth factor receptor

(EGFR) and ALK should be performed in all patients before therapy. Targeted therapy in sensitive mutations with TKI (gfitinib, erlotinib

or afatinib) or crizotinib and ceritinib, respectively, can achieve response rate above 60 % and significantly prolong survival. Platinum

doublet chemotherapy may be considered for all other patients. Bevacizumab can be considered for addition to the doublet in patients

with nonsquamous cancers who have no contraindications. For patients initially treated with a platinum doublet, maintenance chemotherapy

with pemetrexed, erlotinib, gemcitabine, or possibly docetaxel is an option with selection based on clinical features, histology,

type of initial therapy, and response to first-line therapy. Treatment with docetaxel, pemetrexed or erlotinib can prolong survival in

second line therapy. New antiangiogenic drugs nintedanib and ramucirumab were registred for second line treatment together with

docetaxel in last year. Immunotherapy use (antiMUC-1, antiPDL-1) in clinical practice is approaching.

inhibitors of angiogenesis.

Keywords: non-small-cell lung cancer, chemotherapy, molecularly targeted therapy, activation mutations of EGFR, ALK rearrangements,

Published: March 1, 2015  Show citation