Therapeutic decisionmaking in the molecular era

Current treatment based algorithms for NSCLC are often derived from studies that were conducted prior to the extensive wealth of knowledge that was gained by subtyping lung cancer into distinct molecular entities. New studies are now helping to refine strategies for second-line approaches in EGFR-mutated, Alk-rearranged, as well as in EGFR/Alk-unmutated tumours. This review will focus on treatment decisions after the failure of first-line therapy, considering both patient selection and patient preferences. Selected studies that have specifically looked at second-line therapy in EGFR-negative patients will be reviewed and placed into the current context of therapeutic decisions in the molecular era.