Currently, second-line chemotherapy is the standard of care for platinum-pretreated NSCLC even though its efficiency is poor [1], [2] and [5]. Docetaxel and pemetrexed are currently the standard second-line chemotherapy agents for NSCLC.

Treatment with pemetrexed generally results in clinically equivalent efficacy outcomes with docetaxel in the second-line treatment of patients with advanced NSCLC [1]. However, pemetrexed and docetaxel only produced overall response rates (ORRs) of 9.1% and 8.8% with a median survival time of 8.3 and 7.9 months, respectively, RAD001 in vivo in platinum-pretreated NSCLC [1]. The epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) erlotinib and gefitinib have also been used as standard second-line agents in treating NSCLC. Sensitivity to EGFR TKIs is dependent on the activation of the EGFR pathway or the presence of EGFR-interacting proteins [5]. Studies showed that no significant differences in efficacy were noted between patients treated with TKIs and those treated with docetaxel or pemetrexed in platinum-pretreated NSCLC [5], [6] and [7]. Therapeutic inhibition of EGFR with TKIs has resulted in favorable response rates only in 11.14% to 15.25% of platinum-pretreated NSCLC, mostly because the EGFR mutation or gene amplification rate is only 16.6% in NSCLC [5] and [6]. In addition, median survival

of selleck chemicals llc 7.6 months for gefitinib in platinum-pretreated NSCLC and 5.3 months for erlotinib in platinum-resistant NSCLC indicate the desperate need for novel approaches to treat the patient population [5], [7], [8] and [9]. We previously found that 5% ethanol-cisplatin injected intratumorally could eradicate cisplatin-resistant lung tumors and extend survival by improved killing of lung CSCs in mice [10]. We believe that 5% ethanol improves the efficacy of CSC killing by inhibiting breast cancer resistance protein (BRCP/ABCG2) SB-3CT drug transporter function and by improving the penetration of cisplatin into the tumor cells [10]. On the basis of our model organism studies, it is possible that computed tomography (CT)–guided percutaneous fine-needle 5% ethanol-cisplatin intratumoral

injection (CT-PFNECII) might also regress platinum-pretreated or even platinum-resistant tumors in patients with NSCLC by killing chemoresistant cancer stem cells and cancer cells. Furthermore, it is possible that the residual unkilled but damaged tumor cells after 5% ethanol-cisplatin treatment might be more fragile and sensitive to systemic second-line chemotherapy agents. Thus, combination of CT-PFNECII with systemic second-line chemotherapy might provide a new way to improve survival of this patient population. This study is aimed to investigate the efficacy and safety of CT-PFNECII combined with second-line chemotherapy in patients with platinum-pretreated stage IV NSCLC. The study protocol was approved by the Institutional Review Boards of the No.