Background : Overall survival (OS) and quality of life in patients with advanced non small cell lung cancer (NSCLC) remains to the day highly unsatisfactory. Better understanding of the mechanisms of oncogenesis resulted in the development of new drugs, which target a specific stage in tumor development. Additionally, optimal timing of chemotherapy administration has been readdressed with the introduction of maintenance treatment in clinical practice. The aim of this review is to briefly summarize the developments in first line treatment of NSCLC with small molecule tyrosine kinase inhibitors, the role of crizotinib and the current options in maintenance treatment. Methodology A search was performed in the PubMed database and in Clinical Trials.gov using the keywords erlotinib, gefitinib, crizotinib and maintenance treatment. Findings were reported in form of a narrative review. Conclusions : First line treatment with small molecule TKIs for NSCLC is both effective and feasible. EGFR mutation status remains the main prognostic factor of response. Pemetrexed and Erlotinib, currently approved for Maintenance Treatment in NSCLC, seem to benefit patients with advanced disease. Identification of suitable candidates for Maintenance Treatment, optimal timing and agent selection are issues that still remain largely unanswered. Early study results promise that addition of crizotinib to the treatment regimen of ALK positive NSLCL is likely to be beneficiary for a substantial number of patients.
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