Current Management of Unresectable Non-Small-Cell Lung Cancer

ABSTRACT: The past 5 years have witnessed an evolution in the management of unresectable non-small-cell lung cancer (NSCLC) in the United States. Combined-modality treatment with chemotherapy plus irradiation has become the standard of care for stage III (locally advanced) disease. Most patients with stage IIIB disease and cytology-positive pleural effusion are now considered candidates for chemotherapy, as are those with stage IV disease. Studies have suggested that cisplatin (Platinol), either alone or in combination therapy, is likely to improve survival in advanced NSCLC. Several newer agents have also shown activity. As single agents, vinorelbine (Navelbine) and carboplatin (Paraplatin) have resulted in prolonged survival in randomized trials. Combined treatment with cisplatin plus vinorelbine has shown a significant advantage over standard cisplatin-based regimens. The combination of cisplatin and vinorelbine is currently a reasonable community standard for the treatment of NSCLC. Other agents of interest include paclitaxel (Taxol), docetaxel (Taxotere), gemcitabine (Gemzar), and irinotecan (Camptosar). The use of these treatments in combination with other therapies warrants further investigation. [ONCOLOGY 11(Suppl 12):11-15, 1997]

Introduction

The American Cancer Society estimated that 180,000 patients in the United States would develop lung cancer during 1996.[1] Approximately 80% of these patients were expected to have non-small-cell lung cancer. In approximately one-third of cases, the disease is potentially resectable for cure at the time of presentation. Another third of patients have locally advanced disease (stages IIIA and IIIB) that is not surgically approachable de novo with curative intent. The remaining one-third have stage IV disease, implying hematogenous dissemination at the outset. This article describes how management strategies for the latter two groups have evolved during the past 5 years.

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