Gemcitabine and pemetrexed (Alimta) in thoracic cancers: present and future perspectives. Introduction and current...

With more than 1 million new cases annually worldwide, lung cancer remains a major public health problem, and ongoing efforts against tobacco consumption will not modify this situation in the near future. Most patients with lung tumors have advanced disease at the time of presentation and are thus treated with palliative intent. Several new active cytotoxic agents (ie, gemcitabine, irinotecan, the taxanes, and vinorelbine) have emerged during the last decade, and in combination with cisplatin, offer response rates of 35% to 50% and median survival durations of 9 to 11 months. Nevertheless, the results remain disappointing in the majority of cases, and data on long-term survivors are still anecdotal. Several strategies might improve treatment efficacy: administering multidrug combinations to increase antitumor activity, ameliorating the tolerance of chemotherapy, treating patients at an earlier stage of their disease, and developing new agents. This article discusses these promising strategies and places them in proper perspective.