Advances in the Treatment of Metastatic Non–Small-Cell Lung Cancer With Chemotherapy and Targeted Agents

Abstract

In Brief The treatment of non–small-cell lung cancer (NSCLC) is constantly evolving. Recent advances in both the front-line and relapsed/refractory setting have improved patient outcome, whereas in the past, best supportive care was considered the only viable option for patients with advanced or metastatic NSCLC. Improvements in chemotherapeutic regimens and the development of novel targeted agents have resulted in incremental improvements in overall patient survival. The antiangiogenic agent bevacizumab has recently yielded a clinically significant improvement in response rate, progression-free survival, and overall survival for patients with previously untreated nonsquamous recurrent or advanced (stage IIIB/IV) metastatic NSCLC. In the second- and third-line settings, docetaxel, pemetrexed, and inhibitors of the epidermal growth factor receptor, such as erlotinib, have contributed to increased overall time to progression and overall survival. Ongoing clinical trials are currently focusing on generating further improvements in patient outcome by combining novel targeted agents and redefining patient selection criteria to enrich the population that will ultimately receive the optimal therapy for maximal benefit. When examining advanced/metastatic non–small-cell lung cancer treatment options and outcomes historically, a clear advantage with the use of chemotherapy has only been recently realized. It is hoped that the addition of targeted agents to these standard regimens will further improve survival. Recent studies have demonstrated a survival advantage for antiangiogenic or epidermal growth factor receptor-targeted therapy when added to standard chemotherapy for non–small-cell lung cancer, and ongoing studies are addressing the use of other novel agents in this setting.