Second-line (SL) treatment has been shown to improve survival and quality of life outcomes for patients with stage IIIB/IV
non-small cell lung cancer. However, only a minority of patients will receive SL
therapy and the characteristics of this population have not been well described in the literature. In an effort to define the factors that predict who is likely to receive second line treatment, we performed an analysis on 230 patients with stage IIIB or IV
non-small cell lung cancer who received first line
therapy with
carboplatin and
paclitaxel. The median age of these patients was 63, and 144 (63%) were male, 200 (87%) had stage IV disease, 106 (46%) had a KPS of 90-100% and 124 (54%) had a KPS of 70-80%. The median number of cycles of first line
chemotherapy was 4. Of these patients, 101 (44%) received second line
therapy (median age 57 (range 45-76), 50% male and 37% KPS 90-100%). In the univariate analysis, younger age (P = 0.015), high baseline performance status (P = 0.002), non-squamous histology (P = 0.027), female gender (P = 0.0003), two or more cycles of
therapy (P = 0.0004), four or more cycles of
therapy (P = 0.001), and grade 2 or greater neuropathy (P = 0.024) were significantly associated with an increased likelihood of receiving SL
therapy. In the multivariate model, high baseline performance status (OR = 2.05, P = 0.015), female gender (OR = 2.69, P = 0.001), non-squamous histology (OR = 1.98, P = 0.066), and two or more cycles of
therapy (OR = 5.89, P = 0.002) remained significant. In conclusion, less than 50% of patients with stage IIIB/IV
non-small cell lung cancer received SL treatment. Factors increasing the likelihood of second-line
therapy include high performance status, female gender and non-squamous histology, while early termination of first-line
therapy decreased the likelihood of further
therapy.