[Chemotherapy of non-small cell lung cancer: non-cisplatin based combinations]

The rationale for the association of two cytotoxic agents is based on obtaining the best possible synergy with the lowest level of interactive toxicity. The original mechanism of action of gemcitabine makes this drug a logical choice in the treatment of non-small cell lung cancer (NSSLC). Numerous phase I and phase II studies assessing the use of gemcitabine-based combinations in NSSLC are currently underway. These associations without cisplatin will quite naturally be positioned as second line therapy for NSSLC. The high response rates, however, also make these combinations particularly interesting candidates for first-line therapy, and they are shortly to be compared in phase II trials with traditional cisplatin-based treatment regimens. Protocols using cisplatin-based associations already have proven efficacy, but the same is expected to apply to other protocols without cisplatin, particularly those using innovative drugs such as gemcitabine, vinorelbine and taxanes. The different studies already concluded, or those currently underway, therefore constitute a basis for developing sequential treatment strategies in NSSLC. Gemcitabine is one of the new tools available to practitioners to improve patient prognosis in terms of clinical benefits and improved survival.