A new proteomic test could guide treatment decision in second-line therapy for patients with EGFR unselected non-small cell lung cancer?

Nowadays non-small cell lung cancer (NSCLC) is the first cause of death for tumor worldwide. In the second line setting there are few results upon survival parameters from the various treatment options. European Society of Medical Oncology (ESMO) guidelines say that patients clinically or radiologically progressing after first-line chemotherapy, irrespective of administration of maintenance chemotherapy, and with an Eastern Cooperative Oncology Group (ECOG) Performance Status (PS) 0-2, should be offered second-line chemotherapy (1). In this setting, single agents chemotherapy improve disease-related symptoms and overall survival (OS) to nearly 6.7-8.3 months, with 30% of patients alive at 1 year (2,3). Comparable options in the second-line therapy consist of pemetrexed—for non-squamous histology only—or docetaxel. Erlotinib is an additional potential option in patients with PS 0-2 (1). Epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) are the standard treatment option for advanced NSCLC patients harboring EGFR-activating mutations.