Kinesin spindle protein ongation seems to be higher than that for control of symptoms. In clinical practice, this sometimes leads to administering active treatment up until the last weeks of the patient’s life. Many patients would choose chemotherapy for a small benefit in health outcome and for smaller benefit than what their health providers perceive. Patients are concerned about adverse effects less than their physicians are. The desire of patients to receive active treatment until the last weeks of their life has been elucidated in an American retrospective study, which included 417 patients treated for advanced NSCLC. Within this study, 84% of patients received first line treatment, whereas 54%, 26%, 10% and 5% received second, third, fourth and fifth line treatment, respectively. Forty three percent and 20% of patients, received chemotherapy in the last 4 and 2 weeks of their life, respectively. A twelveyear Austrian retrospective study, which included 1,424 NSCLC patients, showed that 501 histamine receptor patients received first line, 172 received second line, 71 received thirdline and 26 patients received fourth line treatment.
The increasing percentage of NSCLC patients receiving third MEK signaling pathway line treatment was also supported by the analysis of the randomised phase III trial that compared pemetrexed to docetaxel as second line treatment. Over 40% of patients in this study received third line therapy post study. Out of those treated with pemetrexed, 32% received docetaxel post study. OS observed in the pemetrexed arm with third line docetaxel was not proven to be different from that observed in patients who received other third line chemotherapy agents. In contrast, a retrospective analysis was performed examining the clinical course of the disease after two or more treatment lines in NSCLC patients with good PS. Those patients who had received third or fourth line chemotherapy after two prior chemotherapy regimens that included platinum and docetaxel administered concurrently or sequentially were eligible. Prior regimens had failed adue to disease progression within 90 days of chemotherapy or due to unacceptable toxicity. Over 700 patient records were examined at one U.S. and one European agomelatine cancer center and 43 patients fulfilled the inclusion criteria. Response rates decreased with each new line of treatment: first line, 20.9%, second line, 16.3%, third line, 2.3%, fourth line.
The disease control rate also decreased dramatically from first to fourthline treatment, although it was higher for second line treatment than for first line. Median OS from the beginning of the last treatment was 4 months. Patients with stage III disease at diagnosis had longer OS than stage IV patients. This study suggests that third line treatment may be ineffective but the number of patients is inadequate to reach such a conclusion. These studies show that a subset of patients with acceptable PS after second line failure seek further treatment. This review tries to highlight the need for novel therapeutic approaches for patients with recurrent NSCLC who present with disease progression after second line treatment. At present, few options are available. Treatment Options Available Chemotherapy. Pemetrexed, approved as maintenance therapy, was recently evaluated by three retrospective studies.