Roche and has received grant or research JNK signaling pathway support from Millenium, Astra Zeneca, and Schering Plough. A.W.K.Y. has served as a paid consultant for Eden, has received honoraria from the speakers bureaus of Schering Plough/MSD, Merck, and Genentech, has played an advisory role for Genentech, Merck, Novartis, Eli Lilly, and Antisense Pharma, and has received research support from Novartis for projects unrelated to the topic of the manuscript. M.P.: has served on the advisory board for Miltenyi Biotech, has received speakers honoraria from Merck Serono, Sigma Tau Pharmaceuticals, and Miltenyi Biotech, and has received unrestricted research funding from Merck Serono and Nuon Therapeutics for projects unrelated to the current manuscript. M. Weiler has no conflict of interest. Until recently, the benefit of second line treatment was controversial. The impact of first line chemotherapy on the outcome of second line chemotherapy was retrospectively investigated 5-HT receptor within a large phase III study that compared docetaxel to pemetrexed in NSCLC patients after first line failure.
Multivariate analysis mGluR showed that gender, stage at diagnosis, PS and best response to first line therapy significantly influenced overall survival. Additionally, histology and time elapsed from first to second line therapy were statistically significant in univariate analysis. Moreover, a systematic review of the literature with metaanalysis of RCTs comparing any approach, namely chemotherapy or epidermal growth factor receptor blockage, with placebo showed a 1 year survival rate benefit for second line treatment. The main objective of a large observational European study was to monitor chemonaive, advanced NSCLC patients outside the clinical trials for eighteen months from initiation of first line chemotherapy. This study, which enrolled 975 patients with a median age of 65 years, showed that second line treatment was planned for 29.2% patients, the median time from initiation of first to second line chemotherapy was 5.8 months, the patients?PS was mainly 0 or 1, and the best response to treatment was as follows: complete response 0.4%, partial response 9.1%, stable disease 19.3%, progressive disease 48.8% and unknown 14.3%. These data suggests that the role of second line marbofloxacin treatment is beneficial in clinical trials as well as outside these settings.
Di Maio et al. recently performed a metaanalysis of six trials in an effort to compare second line doublet chemotherapy to monotherapy and showed that doublet regimens increase progression free survival but are more toxic and do not improve OS. The Rationale Behind Third line Treatment There is no consensus as to whether patients should be offered third line treatment after first and second line treatment failure. The growing availability of both chemotherapeutic and biological agents, as well as controlled toxicity and improvement in BSC, have led to increased numbers of patients requiring further treatment. Many patients who still have good PS and who have exhibited minimal toxicity from previous treatments usually receive third line therapy. Interestingly, some recent studies show that the patients?request to receive active treatments against the disease is stronger than their fear of toxicity.