Lung cancer

The results of the many clinical trials published in 1997 had only modest impact on the treatment results using either cytostatic agents alone or combined with radiotherapy in lung cancer. In SCLC, combination chemotherapy including platin-compounds (cisplatin, carboplatin) and the podophyllotoxins (etoposide and teniposide) continue to be the cornerstone of therapy. Complete plus partial responses to combination chemotherapy occurs in 80-90% of all patients. Median survival is at present 11-17 months, and overall 5-year survival approximately 5% depending on the initial tumor stage. The duration of treatment has been shortened to 5-6 months. In relapsing patients topotecan and paclitaxel appear to have clinical useful activity. For epidermoid, adeno- and large cell carcinoma further support has arisen for the use of preoperative and preirradiatory chemotherapy in stage III NSCLC, but further studies are needed before specific recommendations can be given for general use. For patients with advanced NSCLC, new innovative treatments are still urgently needed. Platin-containing regimens with the inclusion of new agents, such as gemcitabine, taxenes, and navelbine, yielded response rates of 42-55% in phase II trials, but results from large phase III trials are necessary in order to measure the impact of these new agents in the management of NSCLC. Major improvements of therapy for mesothelioma have not occurred within the last year.