Second-Line Treatment Selection in Patients With Non–Small-Cell Lung Cancer of Adenocarcinoma Histology: Findings From a European Survey of Treating Physicians

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Guidelines provide treatment recommendations for advanced non–small-cell lung cancer (NSCLC), but physicians must also consider other factors. We surveyed physicians treating NSCLC to determine their therapy goals, drivers of treatment choice, current prescribing behavior, and therapy expectations.

Materials and Methods

In 2015, an online survey was conducted of 500 pulmonologists/oncologists treating lung adenocarcinoma in Germany, France, Italy, Spain, and the United Kingdom, comprising screening and therapy decision questions.


On average, physicians had 14.7 years of experience and treated 79 patients/3 months with stage IIIb/IV NSCLC. In patients with Eastern Cooperative Oncology Group (ECOG) 0-1, “prolonged survival/extending life” was the main therapy goal of physicians for first- (63%) and second-line (40%) patients; improvement in quality of life (QoL) was the main goal of 14% of physicians for second-line patients. For patients with ECOG ≥2, the main goal of second-line therapy was improvement in QoL (26%) or tumor-related symptoms (23%). Most (57%) physicians strongly agreed that they preferred a second-line treatment that extends overall survival (OS) while maintaining QoL; their greatest dissatisfaction with available second-line treatment options was the inability to “stop tumor progression over the long term” (66%). Physicians expected new therapies to become available within 12 months that would provide improvements in progression-free survival (83%) or OS (69%).


OS is important for second-line treatments in patients with stage IIIb/IV NSCLC, although QoL improvements should not be underestimated. This survey highlights the wait faced by patients and physicians as treatments transition from clinical trials to clinical practice.


An online survey was conducted of 500 physicians treating patients with non–small-cell lung cancer, to determine the drivers behind their prescribing behavior. Extending life was an important factor when treating second-line patients, although improvements in quality of life were also important. This survey highlights the wait for emerging treatments to be translated from clinical trials into clinical practice.

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