Rationale for Non-Platinum Chemotherapy in Advanced NSCLC

ABSTRACT: During the past decade, five new cytotoxic drugs have beenintroduced that are active against non-small-cell lung cancer (NSCLC). Theseagents include vinorelbine (Navelbine), paclitaxel (Taxol), docetaxel(Taxotere), gemcitabine (Gemzar), and irinotecan (CPT-11, Camptosar). Usedalone, these drugs display activity comparable to cisplatin. The combination ofcisplatin and one of the newer drugs produces better survival than treatmentwith cisplatin (Platinol) alone. Randomized studies of chemotherapy regimensthat include these newer drugs have demonstrated improved survival, fewer sideeffects, or both, compared with earlier standard combinations such ascisplatin/vindesine or cisplatin/etoposide. Docetaxel and perhaps some of theother newer drugs are of value for patients previously treated withplatinum-containing regimens. Future studies should determine whethercombinations of these newer drugs are superior to cisplatin-containing regimens.Although improved survival is the most important factor in defining the bestregimen in non-small-cell lung cancer, additional considerations includepatient tolerability, costs of administration, and the rationale for and abilityto include noncytotoxic agents (such as inhibitors of signal transductionpathways or angiogenesis) into the therapeutic program. [ONCOLOGY 15(Suppl8):29-34, 2001]

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