Future randomized trials for non small-cell lung cancer

Combination chemotherapy is the standard of care for management of previously untreated, good performance status patients with advanced non small-cell lung cancer. Most of the regimens in use worldwide are platinum-based doublets. Recent data from the Eastern Cooperative Oncology Group suggest that multiple different platinum-based regimens produce similar response rates and overall survival when used as first-line treatment. In upcoming randomized trials designed to explore possible improvements in therapy, three different strategies are being evaluated. One involves head-to-head comparisons of new, often non-platinum-based doublet combinations with standard platinum-based, two-drug regimens. A second emphasizes the possible benefits of combinations using three cytotoxic agents compared to a two-drug standard. The third is focused on adding a new molecular targeting agent, such as an anti growth factor, growth factor receptor antibody, or an intracellular signal transduction inhibitor, to a standard combination of two cytotoxic drugs. This paper reviews some of the randomized phase III trials exemplifying each of these approaches to therapy for patients with advanced non small-cell lung cancer.