State-of-the-art treatment for advanced non-small-cell lung cancer

Patients with locally advanced or metastatic non-small-cell lung cancer (stage III and IV) who are not candidates for surgery and exhibit good performance status are typically treated with concurrent radiation and platinum-based chemotherapy for disease palliation. Platinum-based chemotherapies, used alone or with radiation therapy, offer a small but significant survival benefit compared with supportive care. The incorporation of first-line agents such as gemcitabine (Gemzar), vinorelbine (Navelbine), and paclitaxel, as well as second-line agents such as docetaxel (Taxotere), in doublet and triplet combinations has had a further significant therapeutic impact. Randomized trials have shown that cisplatin-based therapy in combination with new agents results in improved 1- and 2-year survival rates in patients with adequate performance status. The 1-year survival benefit has significantly improved, with greater symptom relief and improved quality of life in these patients. Thus, delaying disease progression with combination chemotherapy appears both beneficial and cost-effective in patients with advanced non-small-cell lung cancer. Newer approaches--including targeting critical signaling pathways, such as tyrosine kinase receptors, angiogenesis, and downstream signal transduction mechanisms--may provide novel agents with an improved toxicity profile and the potential for better disease management.