Science and Research

Novel active agents in patients with advanced NSCLC without driver mutations who have progressed after first-line chemotherapy

Despite the efficacy of a number of first-line treatments, most patients with advanced-stage non-small cell lung cancer (NSCLC) experience disease progression that warrants further treatment. In this review, we examine the role of novel active agents for patients who progress after first-line therapy and who are not candidates for targeted therapies. More therapeutic options are needed for the management of patients with NSCLC after failure of first-line chemotherapy. A PubMed search was performed for articles from January 2012 to May 2015 using the keywords NSCLC, antiangiogenic, immunotherapy, second-line, novel therapies and English language articles only. Relevant papers were reviewed; papers outside that period were considered on a case-by-case basis. A search of oncology congresses was performed to identify relevant abstracts over this period. In recent years, antiangiogenic agents and immune checkpoint inhibitors have been added to our armamentarium to treat patients with advanced NSCLC who have progressed on first-line chemotherapy. These include nintedanib, a triple angiokinase inhibitor; ramucirumab, a vascular endothelial growth factor receptor-2 antibody; and nivolumab, pembrolizumab and atezolizumab, just three of a growing list of antibodies targeting the programmed death receptor-1 (PD-1)/PD ligand-1 pathway. Predictive and prognostic factors in NSCLC treatment will help to optimise treatment with these novel agents. The approval of new treatments for patients with NSCLC after the failure of first-line chemotherapy has increased options after a decade of few advances, and holds promise for future evolution of the management of NSCLC.

  • Manegold, C.
  • Adjei, A.
  • Bussolino, F.
  • Cappuzzo, F.
  • Crino, L.
  • Dziadziuszko, R.
  • Ettinger, D.
  • Fennell, D.
  • Kerr, K.
  • Le Chevalier, T.
  • Leighl, N.
  • Papotti, M.
  • Paz-Ares, L.
  • Perol, M.
  • Peters, S.
  • Pirker, R.
  • Quoix, E.
  • Reck, M.
  • Smit, E.
  • Vokes, E.
  • van Zandwijk, N.
  • Zhou, C.

Keywords

  • Antiangiogenesis
  • Immune checkpoint inhibitors
  • Nintedanib
  • Prognostic factors
  • Ramucirumab
  • Boehringer Ingelheim, Roche, AstraZeneca, Pfizer, Novartis, Bristol-Myers Squibb
  • and Clovis Oncology. LC has received honoraria from Boehringer Ingelheim, Pfizer,
  • Bristol-Myers Squibb and AstraZeneca. RD has received advisory board and/or
  • lecture fees from Boehringer Ingelheim, Roche, AstraZeneca, Pfizer, Novartis and
  • Clovis Oncology. DE is a consultant for ARIAD Pharmaceuticals, Boehringer
  • Ingelheim, Bristol-Myers Squibb, Eisai, Eli Lilly, EMD Serono, Genentech, Golden
  • Biotech, Helsinn Therapeutics and Sandoz. DF has received consultant fees from
  • Eli Lilly and speaker bureau fees from Bristol-Myers Squibb. KK has received
  • advisory board and/or lecture fees from Eli Lilly, Roche, AstraZeneca, Pfizer,
  • Novartis, Clovis Oncology, Bristol-Myers Squibb and Merck Sharpe & Dohme. TLC has
  • received advisory board and/or lecture fees from Boehringer Ingelheim, Sanofi and
  • Synta. NL is a researcher for the University Health Network, which received a
  • research grant from Novartis. CM has received honoraria for expert study advice
  • and travel support from Boehringer Ingelheim. MP has received research grants
  • from Novartis and honoraria from Eli Lilly, Boehringer Ingelheim, Pfizer and
  • Clovis Oncology. LP-A has given scientific advice to Pfizer, Clovis Oncology,
  • Roche, Boehringer Ingelheim, AstraZeneca, Eli Lilly and Bristol-Myers Squibb. MP
  • has received honoraria for advisory boards from Eli Lilly, Roche and Boehringer
  • Ingelheim. RP has received speaker's fees and honoraria for advisory boards from
  • Boehringer Ingelheim, and honoraria for data safety monitoring board membership
  • from Synta Pharmaceuticals, and Merck Sharpe & Dohme. EQ participated in clinical
  • trials involving nivolumab, pembrolizumab, nintedanib, ramucirumab and
  • ganetespib. MR has received compensated consultant fees from Hoffmann-La Roche,
  • Eli Lilly, Bristol-Myers Squibb, Merck Sharpe & Dohme, AstraZeneca, Pfizer,
  • Novartis, Boehringer Ingelheim and Samsung, and honoraria for lectures from
  • Hoffmann-La Roche, Eli Lilly, Bristol-Myers Squibb, Merck Sharpe & Dohme,
  • AstraZeneca, Pfizer and Boehringer Ingelheim. ES has received honoraria for
  • participating in advisory boards and lecture fees from Boehringer Ingelheim. EV
  • has received consultant/advisory fees from AbbVie, Amgen, AstraZeneca, Boehringer
  • Ingelheim, Celgene, Clovis Oncology, Eisai, Eli Lilly, GeneCentric, Genentech,
  • Merck, Synta, Transgene and VentiRx. CZ has received honoraria from Hoffmann-La
  • Roche, Eli Lilly, Boehringer Ingelheim and AstraZeneca.
Publication details
DOI: 10.1136/esmoopen-2016-000118
Journal: ESMO open
Pages: e000118 
Number: 6
Work Type: Original
Location: ARCN
Disease Area: LC
Partner / Member: Ghd
Access-Number: 29435365
See publication on PubMed

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