Chemotherapy for advanced non-small-cell lung cancer: role of paclitaxel and gemcitabine

OBJECTIVE: To review the role of chemotherapy in advanced non-small-cell lung cancer, focusing on cisplatin-based regimens and two new drugs: paclitaxel and gemcitabine. DATA SOURCES: Medline search of the relevant English literature. STUDY SELECTION: Open and randomised comparative (phases II and III2) studies, and meta-analyses of cytotoxic drugs/regimens used to treat advanced non-small-cell lung cancer. DATA EXTRACTION: The following factors were studied and compared: symptomatic response rates; tumour response rates: median survival time and 1-year survival rates; and side effects of cisplatin-, paclitaxel-, and gemcitabine-based regimens. DATA SYNTHESIS: Using cisplatin-based chemotherapy achieves significant relief of disease-related symptoms of advanced non-small-cell lung cancer and a slight improvement in the median survival time (by approximately 1.5 months). New cytotoxic drugs that are effective and have good safety profiles include paclitaxel and gemcitabine. When used as single agents, these two drugs give response rates of approximately 25%. When used with cisplatin/carboplatin, response rates increase to 45% to 62% and 1-year survival rates increase to 40% to 60%. CONCLUSION: Paclitaxel, gemcitabine, and other drugs such as decetaxel and vinorelbine are promising new chemotherapeutic agents in the treatment of advanced non-small-cell lung cancer. These drugs can palliate disease symptoms and improve the median survival time. The optimal dose and treatment schedules, however, are yet to be defined.