Traitement de 1re ligne des cancers bronchopulmonaires non à petites cellules de stade IV en l'absence d'addiction oncogénique

Abstract

Despite the identification of genetic alteration responsible for tumor genesis in an increasing part of stage IV NSCLC patients, cytotoxic chemotherapy remains the cornerstone of treatment for the vast majority of patients for which there is no targetable oncogenic addiction. First-line chemotherapy remains based on the combination of cisplatin or carboplatin with a third-generation cytotoxic agent for patients with a good performance status (0 or 1). Besides the improvement of supportive care for chemotherapy, several advances have led to improve overall survival of stage IV patients as the consideration of histology for treatment selection, the use of pemetrexed for non-squamous carcinoma, maintenance strategies in first-line, or the addition to chemotherapy of an anti-angiogenic agent in non-squamous carcinoma or an anti-EGFR monoclonal antibody in squamous cell carcinoma. New therapeutic options as immunotherapy will likely lead to a later use of chemotherapy for stage IV NSCLC patients in the next future.