Second-Line Chemotherapy in Advanced Non-Small Cell Lung Cancer (NSCLC): Single Institution Experience

Background: Lung cancer is the leading cause of cancer-related death worldwide. Non-small cell lung cancer (NSCLC) accounts for 80-85 %.Methods: In this retrospective hospital based study, 424 NSCLC patients were enrolled to analyze the prognostic factors and survival after receiving second-line chemotherapy.Results: From 424 NSCLC patients, 236 (55.7%) had stage IIIb-IV disease. The majority (70%, 165/236) of these patients received best supportive care only and 30% (71/236) received first-line chemotherapy. Second-line chemotherapy was administered in 11.9% (28/236) patients after first-line chemotherapy. The median age of patients who received second-line was 58 years. The majority were males (64%). Sixty four percent had stage IV, 57% had an Eastern Cooperative Oncology Group (ECOG) performance status of 2-3, 72% had a body mass index of >18.5 kg/m2 and 57% had history of smoking. The median overall survival was 13 months (95% CI: 6.82-19.18). The first-line chemotherapy was platinum-based combination in all patients, and docetaxel was the second-line treatment in half of the patient. The most common side effects were hematological (93%) and gastrointestinal (78%). Higher risk of mortality was accompanied with age 40-60 years (HR: 5.53, 95% CI: 1.29-23.7, p = 0.022) and stage IV (HR: 3.65, 95% CI: 1.21-11.06, p = 0.022). Multivariate analysis revealed that stage IV had higher risk of mortality than stage IIIb (HR: 3.75, 95% CI 0.969-14.535, p = 0.056). The platinum-taxane combination added 3 months in the median survival (13 vs. 10 months, p = 0.4).Conclusion: Stage IV and age between 40-60 years had a higher risk of death in NSCLC.