Chemoradiation in NSCLC: focus on the role of gemcitabine

Research to identify the optimal drugs for use in chemoradiotherapy has led to the development of the potent radiosensitizing agent gemcitabine (Gemzar), which has exhibited excellent activity in non-small-cell cancer. When used in sequential chemoradiotherapy regimens, gemcitabine has been associated with response rates of 57% to 68%. A full dose of gemcitabine (1,000 mg/m2) can be safely used as induction therapy, and there is no definitive indication of enhancement of radiotoxicity. In addition, results from phase I/II trials support the efficacy of concurrent gemcitabine/radiation therapy in improving overall response rates and overall survival. Rates of 68%, 37%, and 28%, respectively, for 1-, 2-, and 3-year survival have been reported for gemcitabine/cisplatin chemotherapy administered concurrently with radiotherapy. Although the optimal dose has yet to be determined, a weekly dose of 300 mg/m2 appears to be effective with an acceptable toxicity level. Additional clinical trials are warranted to assess the long-term efficacy and safety of gemcitabine in combination with other chemotherapeutic agents and radiation therapy for treatment of non-small-cell lung cancer.