Abstract
Background: Overall survival (OS) and quality of life in patients with advanced non small cell lung cancer (NSCLC) remains to the day highly unsatisfactory. Better understanding of the mechanisms of oncogenesis resulted in the development of new drugs, which target a specific stage in tumor development. Additionally, optimal timing of chemotherapy administration has been readdressed with the introduction of maintenance treatment in clinical practice. The aim of this review is to briefly summarize the developments in first line treatment of NSCLC with small molecule tyrosine kinase inhibitors, the role of crizotinib and the current options in maintenance treatment. Methodology A search was performed in the PubMed database and in Clinical Trials.gov using the keywords erlotinib, gefitinib, crizotinib and maintenance treatment. Findings were reported in form of a narrative review. Conclusions: First line treatment with small molecule TKIs for NSCLC is both effective and feasible. EGFR mutation status remains the main prognostic factor of response. Pemetrexed and Erlotinib, currently approved for Maintenance Treatment in NSCLC, seem to benefit patients with advanced disease. Identification of suitable candidates for Maintenance Treatment, optimal timing and agent selection are issues that still remain largely unanswered. Early study results promise that addition of crizotinib to the treatment regimen of ALK positive NSLCL is likely to be beneficiary for a substantial number of patients.
Highlights
Overall survival (OS) and quality of life in patients with advanced non small cell lung cancer (NSCLC) remains to the day highly unsatisfactory
Optimal timing of chemotherapy administration has been readdressed with the introduction of maintenance treatment in clinical practice
The aim of this review is to briefly summarize the developments in first line treatment of NSCLC with small molecule tyrosine kinase inhibitors, the role of crizotinib and the current options in maintenance treatment
Summary
Overall survival (OS) and quality of life in patients with advanced non small cell lung cancer (NSCLC) remains to the day highly unsatisfactory. The first studies for the use of ΤΚΙs as first line agents produced disappointing results They were performed on patients with NSCLC, without controlling for TKI sensitizing EGFR mutations. Two studies of first line Gefitinib performed on Japanese population positive for EGFR mutations [19,20] showed a response rate of 75%. The IPASS study (Iressa Pan-Asia Study) was a randomized controlled phase III trial which compared first line treatment with TKIs to classical chemotherapy with a platinum doublet. It took place in Asia and included patients who were never smokers or former light smokers, had not received previous treatment and had adenocarcinoma. Testing for these mutations in patients with adenocarcinoma should become routine clinical practice [26]
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