Current options in the treatment of non-small cell lung cancer

Non-small cell lung cancer (NSCLC) is a leading cause of cancer death in industrialised countries, with an overall 5-year survival rate of less than 10%. Good patient performance status is associated with a significantly improved prognosis, whereas the presence of metastases, particularly to the bone or liver, is associated with a poor outcome. Disease staging has largely been standardised using the tumour, node, metastasis (TNM) system, and also provides significant prognostic information. More recently, several biomarkers have been identified in patients with NSCLC, although their prognostic relevance remains to be established. Surgery, when feasible, is the treatment of choice in patients with NSCLC. However, most patients present with locally advanced disease that is not completely resectable. The use of combination chemotherapy regimens has generally been restricted to patients with metastatic, recurrent or unresectable disease, and several relatively active drugs that are generally used in combination have been identified. Combination chemotherapy either alone, or with surgery and/or radiotherapy, has produced some improvements in response rates and, in the neoadjuvant setting, has allowed complete resection in an increased number of patients with otherwise marginally resectable disease. There is also evidence that this approach may increase both disease-free interval and survival time. Thus, the most active chemotherapy regimens (generally those including cisplatin and a vinca alkaloid) appear to provide some benefit in patients with advanced non-small cell lung cancer, but the identification of more active combinations remains a priority.