[Medical treatment of pulmonary neoplasms]

Over the past 20 years, the treatment of lung cancer has improved significantly: platinum-based chemotherapy represents the standard treatment in locally advanced and metastatic non-small cell lung cancer disease because of its impact on survival and quality of life. Adjuvant and neoadjuvant chemotherapy may also play an important role in the betterment of the outcome of earlier stages of disease. New drugs have become part of the therapeutic armamentarium in the treatment of advanced non-small-cell lung cancer. Gemcitabine, taxanes, irinotecan, and vinorelbine have been shown, alone or in combination with platinum derivatives, to interfere with the natural history of disease. As far as small cell lung cancer is concerned, the combination of chemotherapy (cisplatin and etoposide) and radiation therapy has yielded long term survivals in excess of 20%. The role of non-platinum combinations, particularly in the elderly and in patients with poor performance status as well as salvage therapy in patients relapsed after platinum treatment, will be the object of ongoing and future studies. Also the significance of newer agents, such as anti-angiogenesis factors and growth factor receptor inhibitors, used either alone or in combination with standard cytotoxic regimens, will have to be evaluated.