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