Real-world treatment patterns for patients receiving second-line and third-line treatment for advanced non-small cell lung cancer: A systematic review of recently published studies

PLoS One. 2017 Apr 14;12(4):e0175679. doi: 10.1371/journal.pone.0175679. eCollection 2017.


Most patients with advanced non-small cell lung cancer (NSCLC) have a poor prognosis and receive limited benefit from conventional treatments, especially in later lines of therapy. In recent years, several novel therapies have been approved for second- and third-line treatment of advanced NSCLC. In light of these approvals, it is valuable to understand the uptake of these new treatments in routine clinical practice and their impact on patient care. A systematic literature search was conducted in multiple scientific databases to identify observational cohort studies published between January 2010 and March 2017 that described second- or third-line treatment patterns and clinical outcomes in patients with advanced NSCLC. A qualitative data synthesis was performed because a meta-analysis was not possible due to the heterogeneity of the study populations. A total of 12 different study cohorts in 15 articles were identified. In these cohorts, single-agent chemotherapy was the most commonly administered treatment in both the second- and third-line settings. In the 5 studies that described survival from the time of second-line treatment initiation, median overall survival ranged from 4.6 months (95% CI, 3.8-5.7) to 12.8 months (95% CI, 10.7-14.5). There was limited information on the use of biomarker-directed therapy in these patient populations. This systematic literature review offers insights into the adoption of novel therapies into routine clinical practice for second- and third-line treatment of patients with advanced NSCLC. This information provides a valuable real-world context for the impact of recently approved treatments for advanced NSCLC.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Antineoplastic Agents / therapeutic use
  • Biomarkers, Tumor / metabolism
  • Carcinoma, Non-Small-Cell Lung / drug therapy*
  • Carcinoma, Non-Small-Cell Lung / mortality
  • Carcinoma, Non-Small-Cell Lung / pathology
  • Databases, Factual
  • Drug Therapy, Combination
  • Humans
  • Lung Neoplasms / drug therapy*
  • Lung Neoplasms / mortality
  • Lung Neoplasms / pathology
  • Neoplasm Staging
  • Protein Kinase Inhibitors / therapeutic use
  • Survival Rate


  • Antineoplastic Agents
  • Biomarkers, Tumor
  • Protein Kinase Inhibitors

Grants and funding

This study was sponsored by F. Hoffmann-La Roche, Ltd. Ms. Davies, Dr. Waterkamp and Dr. McCusker are employed by F. Hoffmann-La Roche. F. Hoffmann-La Roche provided support in the form of salaries for authors [JD, MM, DW] and also played a role in the decision to publish, and preparation of the manuscript, but did not play a role in the study design, data collection and analysis. The specific roles of these authors are articulated in the ‘author contributions’ section.