Elsevier

Seminars in Oncology

Volume 32, Issue 3, June 2005, Pages 299-314
Seminars in Oncology

Advances in Cytotoxic Chemotherapy for the Treatment of Metastatic or Recurrent Non-Small Cell Lung Cancer

https://doi.org/10.1053/j.seminoncol.2005.02.011Get rights and content

Improvements in drug development and clinical trial design have resulted in a wider range of treatment options for patients with advanced non-small cell lung cancer (NSCLC). Combination chemotherapy is the standard of care for medically fit patients. A variety of chemotherapeutic doublets, including nonplatinum combinations, with similar clinical activity are now available, allowing oncologists to match acceptable toxicity profiles to individual patients’ comorbidities and preferences. Single-agent treatment of refractory or recurrent disease has been shown to improve survival and offer improved quality of life (QOL). For special patient populations, such as the elderly and patients with limited performance status (PS), treatment with single-agent chemotherapy results in modest survival benefits and combination chemotherapy may be appropriate for some of these patients.

Section snippets

First-Line Therapy for Patients With Advanced NSCLC

Over the past decade, a number of phase III trials have been published to help create a standard of care governing the treatment of advanced NSCLC in chemotherapy-naive patients who have good Eastern Cooperative Oncology Group PS (ECOG 0–1). In this section, we will review the roles of platinum-based doublets and nonplatinum-based doublets, the optimal duration of administration of planned initial chemotherapy, and the role of monotherapy and triplets in treatment. It is beyond the scope of

Treatment of Refractory Disease

The 1997 ASCO guidelines stated “there is no current evidence that either confirms or refutes that second-line chemotherapy improves survival with advanced NSCLC.”31 Over the past 8 years, however, a number of trials have demonstrated that chemotherapy can provide benefit for patients with disease progression after initial chemotherapy for advanced NSCLC. Regarding terminology, the phrases second-line therapy and therapy for platinum-refractory disease are no longer interchangable, as now more

Patients With Limited Functional Status

Although patients with advanced NSCLC who have an ECOG PS of 2 constitute a sizable minority of patients with advanced NSCLC, there are limited data to guide clinical decision-making for these patients. The “standard” of care for these patients continues to evolve. Data from randomized trials in this group of patients are largely confined to subgroup analyses of larger trials. Nonetheless, the available data support the use of chemotherapy in this patient population. For example, the

Treatment Paradigm

As chemotherapy currently offers only palliation of symptoms and modest prolongation of life, it is vitally important to determine that the patient truly has stage IV disease, or stage IIIB with a malignant pleural or pericardial effusion, and is therefore not a candidate for treatment with curative intent. Confirmation of advanced disease typically involves pathologic or cytologic documentation of a malignant pleural or pericardial effusion, biopsy-proven metastatic (M1) disease, or convincing

Conclusions and Future Directions

Chemotherapy is an appropriate treatment option for most patients with advanced NSCLC. The growing number of agents with demonstrated activity has improved the ability of oncologists to tailor a regimen for each patient according to toxicity profile, frequency of monitoring, cost, comorbid conditions, and PS. Recent studies have begun to define appropriate management of previously under-represented subpopulations of patients with advanced NSCLC, such as older patients or low PS patients. Many

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