To Treat or Not to Treat Non–Small-Cell Lung Cancer Patients? Current Perspectives

In the 1980s, the introduction of cisplatin (Platinol)-based chemotherapy prolonged survival and improved quality of life in patients with stage III and IV non–small-cell lung cancer. More recently, the use of five new chemotherapeutic agents-docetaxel (Taxotere), gemcitabine (Gemzar), irinotecan (Camptosar), paclitaxel (Taxol), and vinorelbine (Navelbine)-has further improved treatment results for non–small-cell lung cancer. In advanced disease, randomized trials have shown that combinations of these agents produce superior results to older cisplatin-based regimens. Although the new chemotherapeutic agents are more expensive than older drugs, calculations of costs per year of life gained have shown them to be cost-effective. The concurrent use of chemotherapy and chest radiotherapy for stage IIIB disease has produced improvements in survival and quality of life that outweigh increases in toxicity. Neoadjuvant chemotherapy plus surgery has improved survival in patients with stage IIIA disease and mediastinal lymph node involvement, and the role of neoadjuvant radiotherapy is being studied in this setting as well. Finally, trials of neoadjuvant strategies using new-agent combinations are also being conducted in patients with stage I and II non–small-cell lung cancer. [ONCOLOGY 13(Suppl 4):9-15,1999]

Internal server error